| |
21990 Hwy 62 Shady Cove OR 97539-9717 | |
(541) 878-2022 | |
(541) 878-1498 |
Full Name | |
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Speciality | Clinic/Center |
Location | 21990 Hwy 62, Shady Cove, Oregon |
Authorized Official Name and Position | Glen Finley (ADMINISTRATOR) |
Authorized Official Contact | 5418300333 |
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 428 Shady Cove OR 97539-0428 Ph: (541) 878-2022 | 21990 Hwy 62 Shady Cove OR 97539-9717 Ph: (541) 878-2022 |
NPI Number | 1609850940 |
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Provider Enumeration Date | 11/30/2005 |
Last Update Date | 01/30/2013 |
Medicare PECOS PAC ID | 6305839283 |
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Medicare Enrollment ID | O20040406001311 |
Identifier | Type | State | Issuer |
---|---|---|---|
1609850940 | NPI | - | NPPES |
123633 | Medicaid | OR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Provider Name | Kathleen S Finley |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1578547824 PECOS PAC ID: 6406849306 Enrollment ID: I20040414001664 |
Provider Name | Patrick J Gillette |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1578594008 PECOS PAC ID: 6204816135 Enrollment ID: I20040726000176 |
Provider Name | Joy E Ash |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1821033952 PECOS PAC ID: 7315940814 Enrollment ID: I20060823000534 |
Provider Name | Laura L Johnson |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1023348430 PECOS PAC ID: 4789710054 Enrollment ID: I20101007001323 |
Provider Name | Mary J Baker |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1053650960 PECOS PAC ID: 4880832146 Enrollment ID: I20130528000051 |
Rogue Community Health Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 37 Schoolhouse Ln, Shady Cove, OR 97539 Phone: 541-878-1400 | |