| Jennifer Renee Wise, MD | |
|
2821 Daggett Ave Ste 200, Klamath Falls, OR 97601-1106 | |
| (541) 274-8400 | |
| (541) 274-8405 |
| Full Name | Jennifer Renee Wise |
|---|---|
| Gender | Female |
| Speciality | Internal Medicine |
| Location | 2821 Daggett Ave Ste 200, Klamath Falls, Oregon |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255326252 | NPI | - | NPPES |
| P00179641 | Other | NH | RR MEDICARE PIN |
| 3369774 | Other | NH | AETNA PROV # |
| 30203784 | Medicaid | NH | |
| 6000361 | Other | NH | HPHC PIN |
| 101115805 | Other | NH | DOL W/C PIN |
| 30367Y | Other | NH | RAN PIN |
| 5796012 | Other | NH | CIGNA PIN |
| 012016 | Other | NH | TUFTS PIN |
| 01YP05180NH01 | Other | NH | ANTHEM ACES PIN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 12016 (New Hampshire) | Secondary |
| 207R00000X | Internal Medicine | MD192270 (Oregon) | Primary |
| Entity Name | Sky Lakes Medical Center Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1659340370 PECOS PAC ID: 1052204096 Enrollment ID: O20040204000577 |
| Mailing Address | Practice Location Address |
|---|---|
| Jennifer Renee Wise, MD 2865 Daggett Ave, Klamath Falls, OR 97601-1106 Ph: (541) 274-8400 | Jennifer Renee Wise, MD 2821 Daggett Ave Ste 200, Klamath Falls, OR 97601-1106 Ph: (541) 274-8400 |
Dr. Charles Keith Cofas, M.D. Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 2640 Biehn St Ste 4, Klamath Falls, OR 97601 Phone: 541-882-3818 Fax: 541-882-9800 | |
George Kubac, M.D. Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 3001 Daggett Ave Ste 101, Klamath Falls, OR 97601 Phone: 541-884-6233 Fax: 541-880-2840 | |
Dr. Kieran Fredrick Kubac, MD Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 2865 Daggett Ave, Klamath Falls, OR 97601 Phone: 541-274-6150 | |
Dr. Deepika Wali, M.D. Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 2610 Uhrmann Rd, Klamath Falls, OR 97601 Phone: 541-274-4171 | |
Rastislav Kucinsky, MD Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 3001 Daggett Ave Ste 101, Klamath Falls, OR 97601 Phone: 541-884-6233 Fax: 541-880-2840 | |
Dr. Faisal B Saiful, MD Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 2614 Clover Street, Klamath Falls, OR 97601 Phone: 541-884-6233 Fax: 541-880-2840 |