Ventana Wellness, Pc | |
3156 State Street Medford OR 97504-8450 | |
(541) 773-9772 | |
(541) 773-1113 |
Full Name | Ventana Wellness, Pc |
---|---|
Speciality | Family Medicine |
Location | 3156 State Street, Medford, Oregon |
Authorized Official Name and Position | Frank Richard Noodleman (OWNER) |
Authorized Official Contact | 5417739772 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Ventana Wellness, Pc 3156 State Street Medford OR 97504-8450 Ph: (541) 773-9772 | Ventana Wellness, Pc 3156 State Street Medford OR 97504-8450 Ph: (541) 773-9772 |
NPI Number | 1720012339 |
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Provider Enumeration Date | 07/10/2006 |
Last Update Date | 11/16/2015 |
Identifier | Type | State | Issuer |
---|---|---|---|
1720012339 | NPI | - | NPPES |
287179 | Medicaid | OR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 06-00024661 (Oregon) | Primary |
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