Full Name | |
---|---|
Speciality | Family Medicine |
Location | 41 E Ash St, Lebanon, Oregon |
Authorized Official Name and Position | Lance Brandon Large (MEDICAL DIRECTOR) |
Authorized Official Contact | 5034006140 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
1881 W Washington St Stayton OR 97383-9511 Ph: (503) 400-6140 | 41 E Ash St Lebanon OR 97355-3317 Ph: (503) 769-2641 |
NPI Number | 1134604606 |
---|---|
Provider Enumeration Date | 10/01/2018 |
Last Update Date | 06/15/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1134604606 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |