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425 N Santiam Hwy Lebanon OR 97355-4361 | |
(541) 451-6960 | |
(541) 918-5419 |
Full Name | |
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Speciality | Clinic/Center |
Location | 425 N Santiam Hwy, Lebanon, Oregon |
Authorized Official Name and Position | Wendie Wunderwald (CEO) |
Authorized Official Contact | 5414517195 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 1193 Corvallis OR 97339-1193 Ph: (541) 451-6960 | 425 N Santiam Hwy Lebanon OR 97355-4361 Ph: (541) 451-6960 |
NPI Number | 1881950038 |
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Provider Enumeration Date | 04/02/2012 |
Last Update Date | 06/10/2024 |
Medicare PECOS PAC ID | 2769391523 |
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Medicare Enrollment ID | O20180420000512 |
Identifier | Type | State | Issuer |
---|---|---|---|
1881950038 | NPI | - | NPPES |
500651908 | Medicaid | OR |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |