| Wise Mountain Medicine Llc | |
|
335 Ne Revere Ave Bend OR 97701-4059 | |
| (541) 238-7285 | |
| Not Available |
| Full Name | Wise Mountain Medicine Llc |
|---|---|
| Speciality | Clinic/center |
| Location | 335 Ne Revere Ave, Bend, Oregon |
| Authorized Official Name and Position | Carlton Andrew Kelch (CO-OWNER) |
| Authorized Official Contact | 9704061019 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wise Mountain Medicine Llc 2150 Nw Hill St Apt 3 Bend OR 97703-1373 Ph: (970) 406-1019 | Wise Mountain Medicine Llc 335 Ne Revere Ave Bend OR 97701-4059 Ph: (541) 238-7285 |
| NPI Number | 1316512049 |
|---|---|
| Provider Enumeration Date | 05/25/2021 |
| Last Update Date | 05/25/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316512049 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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