| Winding Waters Clinic Pc | |
|
603 Medical Pkwy Enterprise OR 97828-5124 | |
| (541) 426-4502 | |
| (541) 426-6403 |
| Full Name | Winding Waters Clinic Pc |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 603 Medical Pkwy, Enterprise, Oregon |
| Authorized Official Name and Position | Renee E Grandi (PRES) |
| Authorized Official Contact | 5414264502 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Winding Waters Clinic Pc 603 Medical Pkwy Enterprise OR 97828-5124 Ph: (541) 426-4502 | Winding Waters Clinic Pc 603 Medical Pkwy Enterprise OR 97828-5124 Ph: (541) 426-4502 |
| NPI Number | 1053304394 |
|---|---|
| Provider Enumeration Date | 08/23/2005 |
| Last Update Date | 06/29/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053304394 | NPI | - | NPPES |
| OR01145 | Other | OR | MEDICARE EMC SUBMITTER |
| 223198 | Medicaid | OR | |
| CG2920 | Other | OR | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | 383864 (Oregon) | Primary |
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