Kelly R Pettit, MD | |
1253 Nw Canal Blvd, Redmond, OR 97756-1334 | |
(541) 548-8131 | |
(541) 526-6608 |
Full Name | Kelly R Pettit |
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Gender | Male |
Speciality | Emergency Medicine |
Location | 1253 Nw Canal Blvd, Redmond, Oregon |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1659454544 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207P00000X | Emergency Medicine | MD2006-0194 (New Mexico) | Primary |
Entity Name | Kaiser Foundation Health Plan Of The Northwest |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1184786527 PECOS PAC ID: 5799688230 Enrollment ID: O20040130000799 |
Entity Name | Bend Memorial Clinic Pc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1699827477 PECOS PAC ID: 7214936533 Enrollment ID: O20061215000022 |
Mailing Address | Practice Location Address |
---|---|
Kelly R Pettit, MD 275 E 200 S, Salt Lake City, UT 84111-2002 Ph: (800) 366-1884 | Kelly R Pettit, MD 1253 Nw Canal Blvd, Redmond, OR 97756-1334 Ph: (541) 548-8131 |
Catherine Elizabeth Fairgrieve Appel, DO Emergency Medicine Medicare: Medicare Enrolled Practice Location: 1253 Nw Canal Blvd, Redmond, OR 97756 Phone: 541-548-8131 Fax: 541-526-6608 | |
Glynda Gaye Crabtree, MD Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 1253 Nw Canal Blvd, Redmond, OR 97756 Phone: 541-548-8131 Fax: 253-838-6418 | |
Andrew Stokes Kleaveland, MD Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 1253 Nw Canal Blvd, Redmond, OR 97756 Phone: 541-548-8131 Fax: 541-460-4028 | |
Mindy Lipsitz, M.D. Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 1253 Nw Canal Blvd, Redmond, OR 97756 Phone: 541-548-8131 Fax: 541-526-6608 | |
Angus Yatman Ng, MD Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 1253 Nw Canal Blvd, Redmond, OR 97756 Phone: 541-548-8131 Fax: 541-526-6608 | |
Jake Metolius Waits, D.O. Emergency Medicine Medicare: Medicare Enrolled Practice Location: 1253 Nw Canal Blvd, Redmond, OR 97756 Phone: 541-548-8131 Fax: 541-526-6608 | |
Matthew M Eschelbach, DO Emergency Medicine Medicare: Medicare Enrolled Practice Location: 1253 Nw Canal Blvd, Redmond, OR 97756 Phone: 541-548-8131 Fax: 541-526-6608 |