| Earth Song Medical Practice Llc | |
|
18173 Redwood Hwy Selma OR 97538 | |
| (541) 237-4470 | |
| Not Available |
| Full Name | Earth Song Medical Practice Llc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 18173 Redwood Hwy, Selma, Oregon |
| Authorized Official Name and Position | Michael G Pruner (OWNER/MANAGER) |
| Authorized Official Contact | 5412374470 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Earth Song Medical Practice Llc 4567 Deer Creek Rd Selma OR 97538-9612 Ph: (541) 237-4470 | Earth Song Medical Practice Llc 18173 Redwood Hwy Selma OR 97538 Ph: (541) 237-4470 |
| NPI Number | 1912462144 |
|---|---|
| Provider Enumeration Date | 02/01/2019 |
| Last Update Date | 02/01/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912462144 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |