| Visana Wellness, Llc | |
|
603 Hemlock Street 3b Brookings OR 97415-9999 | |
| (541) 469-9100 | |
| (541) 469-9200 |
| Full Name | Visana Wellness, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 603 Hemlock Street, Brookings, Oregon |
| Authorized Official Name and Position | Tracey Stephen Kather (OWNER) |
| Authorized Official Contact | 5412511010 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Visana Wellness, Llc Po Box 6945 Brookings OR 97415-0353 Ph: (541) 469-9100 | Visana Wellness, Llc 603 Hemlock Street 3b Brookings OR 97415-9999 Ph: (541) 469-9100 |
| NPI Number | 1427293349 |
|---|---|
| Provider Enumeration Date | 12/05/2008 |
| Last Update Date | 12/05/2008 |
| Medicare PECOS PAC ID | 7517020936 |
|---|---|
| Medicare Enrollment ID | O20090112000594 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427293349 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 200250089NP (Oregon) | Primary |
| Provider Name | Tracey S Kather |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861538274 PECOS PAC ID: 7214841352 Enrollment ID: I20031113000614 |
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