| Pendleton Primary Care Clinic LLC | |
|
1100 Southgate Ste 11 Pendleton OR 97801-3973 | |
| (541) 966-6916 | |
| (541) 215-1405 |
| Full Name | Pendleton Primary Care Clinic LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 1100 Southgate Ste 11, Pendleton, Oregon |
| Authorized Official Name and Position | Tami J Foster (OFFICE MANAGER) |
| Authorized Official Contact | 5419666916 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pendleton Primary Care Clinic LLC 1100 Southgate Ste 11 Pendleton OR 97801-3973 Ph: (541) 966-6916 | Pendleton Primary Care Clinic LLC 1100 Southgate Ste 11 Pendleton OR 97801-3973 Ph: (541) 966-6916 |
| NPI Number | 1013254432 |
|---|---|
| Provider Enumeration Date | 01/04/2013 |
| Last Update Date | 01/16/2025 |
| Certification Date | 01/16/2025 |
| Medicare PECOS PAC ID | 5193962074 |
|---|---|
| Medicare Enrollment ID | O20241202003555 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013254432 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Primary |
| Provider Name | Nyle C Gunter |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1235753815 PECOS PAC ID: 3072939156 Enrollment ID: I20200819003865 |
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