| Estacada Direct Primary Care, Llc | |
|
107 Nw 5th Ave Estacada OR 97023-7732 | |
| (503) 852-5668 | |
| (971) 399-8728 |
| Full Name | Estacada Direct Primary Care, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 107 Nw 5th Ave, Estacada, Oregon |
| Authorized Official Name and Position | Richard Lee Orth (OWNER) |
| Authorized Official Contact | 5038525668 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Estacada Direct Primary Care, Llc 107 Nw 5th Ave Estacada OR 97023-7732 Ph: (503) 852-5668 | Estacada Direct Primary Care, Llc 107 Nw 5th Ave Estacada OR 97023-7732 Ph: (503) 852-5668 |
| NPI Number | 1801663414 |
|---|---|
| Provider Enumeration Date | 12/05/2023 |
| Last Update Date | 12/05/2023 |
| Medicare PECOS PAC ID | 8426400946 |
|---|---|
| Medicare Enrollment ID | O20240121000149 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801663414 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Richard L Orth |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1750452686 PECOS PAC ID: 6406925247 Enrollment ID: I20080520000008 |
Estacada Chiropractic Clinic Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 437 Ne Main St, Estacada, OR 97023 Phone: 503-630-4037 Fax: 503-630-5636 | |
Orchid Oakridge Clinic, P.c. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 535 Ne 6th Ave, Estacada, OR 97023 Phone: 541-632-3031 |