| Peacehealth Medical Group-dexter | |
|
38843 Dexter Rd Dexter OR 97431-0110 | |
| (541) 937-2134 | |
| Not Available |
| Full Name | Peacehealth Medical Group-dexter |
|---|---|
| Speciality | Clinic/Center |
| Location | 38843 Dexter Rd, Dexter, Oregon |
| Authorized Official Name and Position | Wendy Apland (CFO) |
| Authorized Official Contact | 5416863968 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Peacehealth Medical Group-dexter Po Box 24410 Eugene OR 97402-0451 Ph: (541) 984-4301 | Peacehealth Medical Group-dexter 38843 Dexter Rd Dexter OR 97431-0110 Ph: (541) 937-2134 |
| NPI Number | 1760704878 |
|---|---|
| Provider Enumeration Date | 02/17/2010 |
| Last Update Date | 09/10/2010 |
| Medicare PECOS PAC ID | 6507997475 |
|---|---|
| Medicare Enrollment ID | O20110104001109 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760704878 | NPI | - | NPPES |
| 38 3808 | Other | MEDICARE PART A PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Julie E Kim |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1497796403 PECOS PAC ID: 4486686540 Enrollment ID: I20071203000535 |
| Provider Name | Arnoldo Padilla Vazquez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1861684524 PECOS PAC ID: 4183799976 Enrollment ID: I20080813000301 |
| Provider Name | Kenneth N Hanson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710950324 PECOS PAC ID: 0648310672 Enrollment ID: I20091222000589 |
| Provider Name | Thea E Petersen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083887087 PECOS PAC ID: 0547454027 Enrollment ID: I20101028000680 |
| Provider Name | Mary L Fey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134157332 PECOS PAC ID: 0345238812 Enrollment ID: I20110104001030 |
| Provider Name | Juanita P Doerksen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679546162 PECOS PAC ID: 8820278120 Enrollment ID: I20110203000349 |
| Provider Name | Marika D Wolfe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992966311 PECOS PAC ID: 7517139223 Enrollment ID: I20110930000203 |
| Provider Name | Erik Poyourow |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1750534079 PECOS PAC ID: 4284897315 Enrollment ID: I20120529000399 |
| Provider Name | Alba Virginia Schultz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801164926 PECOS PAC ID: 3173799392 Enrollment ID: I20131203001548 |
| Provider Name | Rechelle L Asirot |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902118417 PECOS PAC ID: 1153546858 Enrollment ID: I20140714002492 |
| Provider Name | Sushanth Nayak |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710273958 PECOS PAC ID: 0648412627 Enrollment ID: I20140820002891 |
| Provider Name | Ehsan Hazrat |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043564586 PECOS PAC ID: 4587979844 Enrollment ID: I20150814013921 |
| Provider Name | John M Malleis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144511643 PECOS PAC ID: 7315183910 Enrollment ID: I20151223000525 |
| Provider Name | Linda F Mcintyre |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437510765 PECOS PAC ID: 9335438019 Enrollment ID: I20160519001077 |
| Provider Name | Marta E Hantke |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508094442 PECOS PAC ID: 7012155385 Enrollment ID: I20160527001463 |
| Provider Name | Rebecca Mcbride |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487044376 PECOS PAC ID: 7719208834 Enrollment ID: I20160811002731 |
| Provider Name | Titus B Kosgei |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376099572 PECOS PAC ID: 9931487949 Enrollment ID: I20161026001283 |
| Provider Name | Logan J Mcghan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689965204 PECOS PAC ID: 7113229865 Enrollment ID: I20170517000006 |
| Provider Name | Myra E Deline |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689149361 PECOS PAC ID: 5890030993 Enrollment ID: I20181218002164 |
| Provider Name | Laurel Lynne Merz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124508494 PECOS PAC ID: 8022347665 Enrollment ID: I20200817003594 |
| Provider Name | Sarah D Crowe May |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467845388 PECOS PAC ID: 8921352576 Enrollment ID: I20200914000927 |
| Provider Name | Amy Marie Keech |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1639468697 PECOS PAC ID: 0749423630 Enrollment ID: I20210512003192 |
| Provider Name | Lily Mahala Cranor |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760989487 PECOS PAC ID: 0840624029 Enrollment ID: I20210817002673 |
| Provider Name | Desiree M Dennull |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639793995 PECOS PAC ID: 3072983675 Enrollment ID: I20221222001589 |
| Provider Name | Deirdre Simpson-rhoads |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417496316 PECOS PAC ID: 8820453814 Enrollment ID: I20230426001519 |
Cottage Grove Community Medical Ct Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 38843 Dexter Rd, Dexter, OR 97431 Phone: 541-767-5200 | |
The Lakeside Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 38843 Dexter Rd, Dexter, OR 97431 Phone: 541-937-2134 Fax: 541-937-1370 |