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799 Long St Sweet Home OR 97386-3304 | |
(541) 367-3888 | |
(541) 367-2407 |
Full Name | |
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Speciality | Clinic/Center |
Location | 799 Long St, Sweet Home, Oregon |
Authorized Official Name and Position | Sherlyn Dahl (HEALTH CENTER DIRECTOR) |
Authorized Official Contact | 5417662131 |
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 579 Corvallis OR 97339-0579 Ph: (541) 766-6190 | 799 Long St Sweet Home OR 97386-3304 Ph: (541) 367-3888 |
NPI Number | 1801278015 |
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Provider Enumeration Date | 06/24/2015 |
Last Update Date | 10/01/2019 |
Medicare PECOS PAC ID | 6709858020 |
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Medicare Enrollment ID | O20151211000554 |
Identifier | Type | State | Issuer |
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1801278015 | NPI | - | NPPES |
227701 | Medicaid | OR |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |