| Village Healthcare Of Corvallis | |
|
656 Nw Mirador Pl Corvallis OR 97330-4698 | |
| (541) 624-2040 | |
| (503) 200-2258 |
| Full Name | Village Healthcare Of Corvallis |
|---|---|
| Speciality | Clinic/Center |
| Location | 656 Nw Mirador Pl, Corvallis, Oregon |
| Authorized Official Name and Position | Renee Edwards (MANAGER PROVIDER PRESIDENT) |
| Authorized Official Contact | 5415520386 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Village Healthcare Of Corvallis 656 Nw Mirador Pl Corvallis OR 97330-4698 Ph: (541) 552-0386 | Village Healthcare Of Corvallis 656 Nw Mirador Pl Corvallis OR 97330-4698 Ph: (541) 624-2040 |
| NPI Number | 1154555076 |
|---|---|
| Provider Enumeration Date | 05/06/2009 |
| Last Update Date | 11/19/2019 |
| Medicare PECOS PAC ID | 5890843411 |
|---|---|
| Medicare Enrollment ID | O20090507000602 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154555076 | NPI | - | NPPES |
| 131713 | Medicaid | OR | |
| 269505 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 200450130NP (Oregon) | Primary |
| 305S00000X | Point Of Service | (* (Not Available)) | Secondary |
| Provider Name | Renee M Edwards |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346241262 PECOS PAC ID: 0042255994 Enrollment ID: I20050622000411 |
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