| |
3620 Nw Samaritan Dr Ste 202 Corvallis OR 97330-3785 | |
(541) 574-4810 | |
(541) 574-4965 |
Full Name | |
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Speciality | Family Medicine |
Location | 3620 Nw Samaritan Dr Ste 202, Corvallis, Oregon |
Authorized Official Name and Position | Joseph M Cahill (CEO-GSRMC) |
Authorized Official Contact | 5417687914 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 1189 Corvallis OR 97339-1189 Ph: (541) 768-6768 | 3620 Nw Samaritan Dr Ste 202 Corvallis OR 97330-3785 Ph: (541) 574-4810 |
NPI Number | 1750647905 |
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Provider Enumeration Date | 04/02/2012 |
Last Update Date | 08/01/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1750647905 | NPI | - | NPPES |
500651475 | Medicaid | OR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 14-1074 (Oregon) | Primary |
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