Full Name | |
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Speciality | Clinic/Center |
Location | 671 Sw Main, Winston, Oregon |
Authorized Official Name and Position | Michelle M Watson (MANAGER) |
Authorized Official Contact | 5414924550 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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P.o Box 12 Winston OR 97496-0012 Ph: (541) 492-4550 | 671 Sw Main Winston OR 97496-0012 Ph: (541) 492-4550 |
NPI Number | 1912061755 |
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Provider Enumeration Date | 12/19/2006 |
Last Update Date | 06/10/2019 |
Medicare PECOS PAC ID | 4587662887 |
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Medicare Enrollment ID | O20091014000564 |
Identifier | Type | State | Issuer |
---|---|---|---|
1912061755 | NPI | - | NPPES |
007151 | Medicaid | OR |