| Prevention Plus Clinic | |
|
1800 Centennial Blvd Suite #6 Springfield OR 97477-4385 | |
| (541) 726-2179 | |
| Not Available |
| Full Name | Prevention Plus Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 1800 Centennial Blvd, Springfield, Oregon |
| Authorized Official Name and Position | Alison Erde (SOLE MEMBER) |
| Authorized Official Contact | 5417261865 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prevention Plus Clinic 1800 Centennial Blvd 6 Springfield OR 97477-4385 Ph: (541) 726-2179 | Prevention Plus Clinic 1800 Centennial Blvd Suite #6 Springfield OR 97477-4385 Ph: (541) 726-2179 |
| NPI Number | 1508190661 |
|---|---|
| Provider Enumeration Date | 09/22/2009 |
| Last Update Date | 10/26/2009 |
| Medicare PECOS PAC ID | 4789723115 |
|---|---|
| Medicare Enrollment ID | O20091125000080 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508190661 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | MD23479 (Oregon) | Primary |
| Provider Name | Alison J Erde |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760434385 PECOS PAC ID: 2567449879 Enrollment ID: I20040706000369 |
| Provider Name | Regina M Fiacco |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1518934751 PECOS PAC ID: 6608855671 Enrollment ID: I20120815000231 |
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