| Open Space | |
|
758 Nw 1st St Enterprise OR 97828-1527 | |
| (541) 426-4502 | |
| Not Available |
| Full Name | Open Space |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 758 Nw 1st St, Enterprise, Oregon |
| Authorized Official Name and Position | Keli Jean Dennis (COO) |
| Authorized Official Contact | 5414264502 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Open Space 603 Medical Pkwy Enterprise OR 97828-5124 Ph: (541) 426-4502 | Open Space 758 Nw 1st St Enterprise OR 97828-1527 Ph: (541) 426-4502 |
| NPI Number | 1518426493 |
|---|---|
| Provider Enumeration Date | 03/19/2019 |
| Last Update Date | 09/12/2023 |
| Certification Date | 09/12/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518426493 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | () | Primary |
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