| Pmg South Shady Cove | |
|
25 Erickson Avenue Shady Cove OR 97539 | |
| (541) 878-3730 | |
| Not Available |
| Full Name | Pmg South Shady Cove |
|---|---|
| Speciality | Clinic/center |
| Location | 25 Erickson Avenue, Shady Cove, Oregon |
| Authorized Official Name and Position | John Jackson (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 5417326000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pmg South Shady Cove Po Box 3158 Portland OR 97208-3158 Ph: () - | Pmg South Shady Cove 25 Erickson Avenue Shady Cove OR 97539 Ph: (541) 878-3730 |
| NPI Number | 1881770808 |
|---|---|
| Provider Enumeration Date | 10/31/2006 |
| Last Update Date | 04/11/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881770808 | NPI | - | NPPES |
| CG6801 | Other | OR | RAIL ROAD MEDICARE |
| 288483 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Health Care By House Call Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 387 Pinetop Terrace, Shady Cove, OR 97539 Phone: 541-878-3537 | |
Shady Cove Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 21990 Hwy 62, Shady Cove, OR 97539 Phone: 541-878-2022 Fax: 541-878-1498 | |
Rogue Community Health Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 37 Schoolhouse Ln, Shady Cove, OR 97539 Phone: 541-878-1400 |