| Canyon Creek Clinic | |
|
235 S Canyon Blvd John Day OR 97845-1044 | |
| (541) 575-1263 | |
| (541) 575-0233 |
| Full Name | Canyon Creek Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 235 S Canyon Blvd, John Day, Oregon |
| Authorized Official Name and Position | Shawna Clark (PRESIDENT) |
| Authorized Official Contact | 5415751263 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Canyon Creek Clinic 235 S Canyon Blvd John Day OR 97845-1044 Ph: (541) 575-1263 | Canyon Creek Clinic 235 S Canyon Blvd John Day OR 97845-1044 Ph: (541) 575-1263 |
| NPI Number | 1356952048 |
|---|---|
| Provider Enumeration Date | 08/14/2020 |
| Last Update Date | 06/22/2021 |
| Medicare PECOS PAC ID | 4284054917 |
|---|---|
| Medicare Enrollment ID | O20201020000657 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356952048 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Shawna Arlene Clark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962798793 PECOS PAC ID: 8628248655 Enrollment ID: I20110831000476 |
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