Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 211 East 2nd St, Wallowa, Oregon |
Authorized Official Name and Position | Joseph Wanner (CFO) |
Authorized Official Contact | 5414265460 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
601 Medical Pkwy Enterprise OR 97828-5124 Ph: (541) 426-5460 | 211 East 2nd St Wallowa OR 97885 Ph: (541) 426-7900 |
NPI Number | 1508452160 |
---|---|
Provider Enumeration Date | 12/17/2020 |
Last Update Date | 01/31/2023 |
Medicare PECOS PAC ID | 4183537566 |
---|---|
Medicare Enrollment ID | O20210203002888 |
Identifier | Type | State | Issuer |
---|---|---|---|
1508452160 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Winding Waters Clinic Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 203 E First Street, Wallowa, OR 97885 Phone: 541-886-2431 Fax: 541-886-2211 |