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1289 49th Ave Ste 102 Sweet Home OR 97386-3230 | |
(541) 451-6250 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 1289 49th Ave Ste 102, Sweet Home, Oregon |
Authorized Official Name and Position | Daniel Rackham (CEO-SLCH) |
Authorized Official Contact | 5417686768 |
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 1189 Corvallis OR 97339-1189 Ph: (541) 768-4410 | 1289 49th Ave Ste 102 Sweet Home OR 97386-3230 Ph: (541) 451-6250 |
NPI Number | 1528334125 |
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Provider Enumeration Date | 03/28/2012 |
Last Update Date | 12/09/2024 |
Medicare PECOS PAC ID | 2769391523 |
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Medicare Enrollment ID | O20180419002426 |
Identifier | Type | State | Issuer |
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1528334125 | NPI | - | NPPES |
500651457 | Medicaid | OR |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |