| Pine Street Open Door | |
|
403 Pine St Klamath Falls OR 97601-6020 | |
| (541) 851-8110 | |
| Not Available |
| Full Name | Pine Street Open Door |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 403 Pine St, Klamath Falls, Oregon |
| Authorized Official Name and Position | Jeana Masters (RO) |
| Authorized Official Contact | 5418802011 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pine Street Open Door 2074 S 6th St Klamath Falls OR 97601-3372 Ph: (541) 851-8110 | Pine Street Open Door 403 Pine St Klamath Falls OR 97601-6020 Ph: (541) 851-8110 |
| NPI Number | 1548999667 |
|---|---|
| Provider Enumeration Date | 06/06/2022 |
| Last Update Date | 02/06/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548999667 | NPI | - | NPPES |
| R101150 | Other | OR | MEDICARE-B |
| 170061 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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