| Southern Oregon Behavioral Wellness Center | |
|
1148 Stanford Ave Medford OR 97504-8924 | |
| (541) 591-7838 | |
| Not Available |
| Full Name | Southern Oregon Behavioral Wellness Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1148 Stanford Ave, Medford, Oregon |
| Authorized Official Name and Position | Lauren J Oxholm (MANAGER) |
| Authorized Official Contact | 5417095056 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Oregon Behavioral Wellness Center 1609 E Barnett Rd Medford OR 97504-8284 Ph: (541) 790-5056 | Southern Oregon Behavioral Wellness Center 1148 Stanford Ave Medford OR 97504-8924 Ph: (541) 591-7838 |
| NPI Number | 1801408901 |
|---|---|
| Provider Enumeration Date | 08/19/2020 |
| Last Update Date | 05/19/2021 |
| Certification Date | 09/14/2020 |
| Medicare PECOS PAC ID | 1153730536 |
|---|---|
| Medicare Enrollment ID | O20210514002482 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801408901 | NPI | - | NPPES |
| Provider Name | Luis F Oxholm |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407843725 PECOS PAC ID: 3577551357 Enrollment ID: I20150319002344 |
| Provider Name | Laurie Dahl |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881087245 PECOS PAC ID: 0244549814 Enrollment ID: I20151021002412 |
| Provider Name | Nicolette A Cortez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194356006 PECOS PAC ID: 6507293784 Enrollment ID: I20221010000847 |
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