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3950 17th St Ste A Baker City OR 97814-1300 | |
(541) 523-1001 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 3950 17th St Ste A, Baker City, Oregon |
Authorized Official Name and Position | Kathryn Fowler (SENIOR VP, CFO) |
Authorized Official Contact | 2083818717 |
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 640 Boise ID 83701-0640 Ph: (208) 381-2222 | 3950 17th St Ste A Baker City OR 97814-1300 Ph: (541) 523-1001 |
NPI Number | 1336442607 |
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Provider Enumeration Date | 12/08/2010 |
Last Update Date | 12/08/2022 |
Medicare PECOS PAC ID | 4981878402 |
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Medicare Enrollment ID | O20161019002551 |
Identifier | Type | State | Issuer |
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1336442607 | NPI | - | NPPES |
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