| Quality Life Family Practice, Llc | |
|
1201 Ne 7th St Ste E Grants Pass OR 97526-1451 | |
| (541) 314-4894 | |
| (541) 314-4895 |
| Full Name | Quality Life Family Practice, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1201 Ne 7th St Ste E, Grants Pass, Oregon |
| Authorized Official Name and Position | Darlena Pike (FNP/CO-OWNER) |
| Authorized Official Contact | 5413144894 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Quality Life Family Practice, Llc 1201 Ne 7th St Ste E Grants Pass OR 97526-1451 Ph: (541) 314-4894 | Quality Life Family Practice, Llc 1201 Ne 7th St Ste E Grants Pass OR 97526-1451 Ph: (541) 314-4894 |
| NPI Number | 1689279184 |
|---|---|
| Provider Enumeration Date | 12/02/2020 |
| Last Update Date | 04/20/2021 |
| Medicare PECOS PAC ID | 4486053105 |
|---|---|
| Medicare Enrollment ID | O20210601001246 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689279184 | NPI | - | NPPES |
| 500642365 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Darlena Pike |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255614160 PECOS PAC ID: 3971778481 Enrollment ID: I20111213000042 |
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