| South West Internal Medicine Llc | |
|
209 N Central Blvd Coquille OR 97423-1274 | |
| (541) 329-0144 | |
| (541) 329-0143 |
| Full Name | South West Internal Medicine Llc |
|---|---|
| Speciality | General Practice |
| Location | 209 N Central Blvd, Coquille, Oregon |
| Authorized Official Name and Position | Douglas Crane (OWNER) |
| Authorized Official Contact | 5413290144 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South West Internal Medicine Llc Po Box 194 Coquille OR 97423-0194 Ph: (541) 329-0144 | South West Internal Medicine Llc 209 N Central Blvd Coquille OR 97423-1274 Ph: (541) 329-0144 |
| NPI Number | 1497203194 |
|---|---|
| Provider Enumeration Date | 09/12/2016 |
| Last Update Date | 02/01/2023 |
| Medicare PECOS PAC ID | 1052691987 |
|---|---|
| Medicare Enrollment ID | O20170313002271 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497203194 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Pauletta J Tokich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578663332 PECOS PAC ID: 7911906482 Enrollment ID: I20080311000375 |
| Provider Name | Douglas G Crane |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1689650673 PECOS PAC ID: 4284775461 Enrollment ID: I20100111000105 |
| Provider Name | Pamela E Namenyi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013164771 PECOS PAC ID: 2860640802 Enrollment ID: I20150430000677 |
| Provider Name | Karen J Olson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215154232 PECOS PAC ID: 0446402549 Enrollment ID: I20200818001374 |
| Provider Name | Stanley Clair Pense |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1255304903 PECOS PAC ID: 3577556372 Enrollment ID: I20230913002997 |
Coquille Valley Hospital District Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 940 E 5th St, Coquille, OR 97423 Phone: 952-653-2565 Fax: 952-653-2540 |