The Bonanza Clinic | |
125 North Lincoln Street Merrill OR 97633-0000 | |
(541) 798-5074 | |
(541) 798-5076 |
Full Name | The Bonanza Clinic |
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Speciality | Clinic/Center |
Location | 125 North Lincoln Street, Merrill, Oregon |
Authorized Official Name and Position | Michael Aaron Sheets (OWNER OPERATOR) |
Authorized Official Contact | 5415451820 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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The Bonanza Clinic Po Box 1030 Merrill OR 97633-1030 Ph: (541) 798-5074 | The Bonanza Clinic 125 North Lincoln Street Merrill OR 97633-0000 Ph: (541) 798-5074 |
NPI Number | 1730181926 |
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Provider Enumeration Date | 06/01/2005 |
Last Update Date | 08/05/2024 |
Medicare PECOS PAC ID | 6002024072 |
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Medicare Enrollment ID | O20120308000581 |
Identifier | Type | State | Issuer |
---|---|---|---|
1730181926 | NPI | - | NPPES |
R162513 | Other | OR | MEDICARE NUMBER |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | 93006519 (Oregon) | Primary |
Provider Name | Michael Sheets |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1548262876 PECOS PAC ID: 3274741244 Enrollment ID: I20110111000851 |
Merrill Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 125 N Lincoln St, Merrill, OR 97633 Phone: 541-798-5074 Fax: 541-798-5076 |