| Creekside Family Medicine | |
|
2859 State St Suite 103 Medford OR 97504-4348 | |
| (541) 282-6580 | |
| (541) 326-0361 |
| Full Name | Creekside Family Medicine |
|---|---|
| Speciality | Clinic/Center |
| Location | 2859 State St, Medford, Oregon |
| Authorized Official Name and Position | Stephen Lanier Nelson (LLC MEMBER) |
| Authorized Official Contact | 5412826580 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Creekside Family Medicine 2859 State St Suite 103 Medford OR 97504-4348 Ph: (541) 282-6580 | Creekside Family Medicine 2859 State St Suite 103 Medford OR 97504-4348 Ph: (541) 282-6580 |
| NPI Number | 1992922595 |
|---|---|
| Provider Enumeration Date | 04/18/2007 |
| Last Update Date | 07/11/2018 |
| Medicare PECOS PAC ID | 5890044960 |
|---|---|
| Medicare Enrollment ID | O20180822002812 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992922595 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Stephen L Nelson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356362008 PECOS PAC ID: 5698778009 Enrollment ID: I20060824000041 |
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