| Club Northwest | |
|
2160 Nw Vine St Grants Pass OR 97526-8439 | |
| (541) 955-2582 | |
| Not Available |
| Full Name | Club Northwest |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 2160 Nw Vine St, Grants Pass, Oregon |
| Authorized Official Name and Position | Stacy Rae Cappadona (REGISTERED DIETITIAN) |
| Authorized Official Contact | 5419552582 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Club Northwest 2160 Nw Vine St Grants Pass OR 97526-8439 | Club Northwest 2160 Nw Vine St Grants Pass OR 97526-8439 Ph: (541) 955-2582 |
| NPI Number | 1356854830 |
|---|---|
| Provider Enumeration Date | 11/07/2017 |
| Last Update Date | 11/07/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356854830 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (NU) | Primary |
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