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114 Se Church St Sublimity OR 97385-9714 | |
(503) 769-2259 | |
(503) 769-8049 |
Full Name | |
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Speciality | Clinic/Center |
Location | 114 Se Church St, Sublimity, Oregon |
Authorized Official Name and Position | Maggie Hudson (COO/CFO) |
Authorized Official Contact | 5037699236 |
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 886 Sublimity OR 97385-0886 Ph: (503) 769-2259 | 114 Se Church St Sublimity OR 97385-9714 Ph: (503) 769-2259 |
NPI Number | 1518354547 |
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Provider Enumeration Date | 04/16/2015 |
Last Update Date | 04/16/2015 |
Medicare PECOS PAC ID | 6103729751 |
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Medicare Enrollment ID | O20150209001771 |
Identifier | Type | State | Issuer |
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1518354547 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |