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200 Mullins Dr Lebanon OR 97355-3983 | |
(541) 259-0200 | |
Not Available |
Full Name | |
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Speciality | Family Medicine - Adult Medicine |
Location | 200 Mullins Dr, Lebanon, Oregon |
Authorized Official Name and Position | Kevin Shaw (CFO/TREASURER) |
Authorized Official Contact | 9094695401 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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795 E 2nd St Suite 5 Pomona CA 91766-2007 Ph: (909) 865-2565 | 200 Mullins Dr Lebanon OR 97355-3983 Ph: (541) 259-0200 |
NPI Number | 1639555170 |
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Provider Enumeration Date | 08/06/2015 |
Last Update Date | 08/06/2015 |
Identifier | Type | State | Issuer |
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1639555170 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207QA0505X | Family Medicine - Adult Medicine | 38807996 (Oregon) | Primary |