| Pine Springs Health LLC | |
|
711 Ne Irving Ave Bend OR 97701-4738 | |
| (541) 330-9110 | |
| Not Available |
| Full Name | Pine Springs Health LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 711 Ne Irving Ave, Bend, Oregon |
| Authorized Official Name and Position | Divya Sharma (OWNER) |
| Authorized Official Contact | 5414802807 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pine Springs Health LLC 711 Ne Irving Ave Bend OR 97701-4738 Ph: (541) 330-9110 | Pine Springs Health LLC 711 Ne Irving Ave Bend OR 97701-4738 Ph: (541) 330-9110 |
| NPI Number | 1013697994 |
|---|---|
| Provider Enumeration Date | 07/24/2023 |
| Last Update Date | 12/06/2024 |
| Certification Date | 12/04/2024 |
| Medicare PECOS PAC ID | 0547617797 |
|---|---|
| Medicare Enrollment ID | O20231108003996 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013697994 | NPI | - | NPPES |
| 500830385 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Primary |
| Provider Name | Divya Sharma |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083679393 PECOS PAC ID: 6204875974 Enrollment ID: I20121106000685 |
| Provider Name | Mariam Hameed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285385922 PECOS PAC ID: 7416313416 Enrollment ID: I20230517002395 |
| Provider Name | Micaela Marie Scafani |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1194504803 PECOS PAC ID: 4486007788 Enrollment ID: I20240201003540 |
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