| Mavie Llc | |
|
1220 Yoke Rd La Pine OR 97739-8981 | |
| (864) 905-7900 | |
| (864) 878-1528 |
| Full Name | Mavie Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1220 Yoke Rd, La Pine, Oregon |
| Authorized Official Name and Position | Ravikumar Patel (PARTNER) |
| Authorized Official Contact | 8649057900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mavie Llc 700 Hendricks Rd Pickens SC 29671-9334 Ph: (864) 878-1528 | Mavie Llc 1220 Yoke Rd La Pine OR 97739-8981 Ph: (864) 905-7900 |
| NPI Number | 1366270365 |
|---|---|
| Provider Enumeration Date | 07/23/2024 |
| Last Update Date | 10/14/2024 |
| Certification Date | 10/14/2024 |
| Medicare PECOS PAC ID | 8325588809 |
|---|---|
| Medicare Enrollment ID | O20240923003134 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366270365 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Shirley Parks |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396927000 PECOS PAC ID: 5698814176 Enrollment ID: I20241118001915 |
| Provider Name | Shirley Parks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396927000 PECOS PAC ID: 5698814176 Enrollment ID: I20250103001694 |