| Siskiyou Community Health Center, Inc | |
|
1701 Nw Hawthorne Ave Grants Pass OR 97526-1257 | |
| (541) 471-3455 | |
| (541) 471-1439 |
| Full Name | Siskiyou Community Health Center, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1701 Nw Hawthorne Ave, Grants Pass, Oregon |
| Authorized Official Name and Position | Richard Booth (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 5419556053 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Siskiyou Community Health Center, Inc 1701 Nw Hawthorne Ave Grants Pass OR 97526-1257 Ph: (541) 955-6053 | Siskiyou Community Health Center, Inc 1701 Nw Hawthorne Ave Grants Pass OR 97526-1257 Ph: (541) 471-3455 |
| NPI Number | 1427046903 |
|---|---|
| Provider Enumeration Date | 10/10/2005 |
| Last Update Date | 10/06/2021 |
| Medicare PECOS PAC ID | 6305747288 |
|---|---|
| Medicare Enrollment ID | O20040114000536 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427046903 | NPI | - | NPPES |
| 127725 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 127725 (Oregon) | Primary |
| Provider Name | Kristin K Miller |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740272285 PECOS PAC ID: 2466353255 Enrollment ID: I20040205001170 |
| Provider Name | David N Procknow |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1780752782 PECOS PAC ID: 7012906951 Enrollment ID: I20040507000076 |
| Provider Name | Linford S Beachy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942289277 PECOS PAC ID: 8527081918 Enrollment ID: I20060111001203 |
| Provider Name | Louise Elizabeth Leduc |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093995995 PECOS PAC ID: 2264325646 Enrollment ID: I20080925000266 |
| Provider Name | Daniel M Mcdonnell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568633584 PECOS PAC ID: 0941342257 Enrollment ID: I20100126000072 |
| Provider Name | Jill D Lary |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457676165 PECOS PAC ID: 7719010859 Enrollment ID: I20100727000299 |
| Provider Name | Richard J Harper |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1912910530 PECOS PAC ID: 7012197874 Enrollment ID: I20110210000790 |
| Provider Name | Amy Leigh Wills |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346653102 PECOS PAC ID: 7618192923 Enrollment ID: I20140630001221 |
| Provider Name | Nichole L Steward |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225497472 PECOS PAC ID: 7719284421 Enrollment ID: I20160323002520 |
| Provider Name | Paloma S Kolkow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275081184 PECOS PAC ID: 2769770338 Enrollment ID: I20161013002640 |
| Provider Name | Ann M Flinders |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699154336 PECOS PAC ID: 7719290717 Enrollment ID: I20161208002097 |
| Provider Name | Christian S Holland |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1205045564 PECOS PAC ID: 3577624501 Enrollment ID: I20170131001853 |
| Provider Name | Robin H Celkupa |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477835478 PECOS PAC ID: 7012286362 Enrollment ID: I20170630000602 |
| Provider Name | Andrew Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427563337 PECOS PAC ID: 8426319963 Enrollment ID: I20180226002215 |
| Provider Name | Lisa Ann Edwards |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588151567 PECOS PAC ID: 3375711823 Enrollment ID: I20180625001458 |
| Provider Name | Peter Clemens |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487858940 PECOS PAC ID: 6103814256 Enrollment ID: I20190222001667 |
| Provider Name | Alisha N Zauher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255976197 PECOS PAC ID: 2567897770 Enrollment ID: I20200129001782 |
| Provider Name | Dustin Durham |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740694397 PECOS PAC ID: 7810119294 Enrollment ID: I20200814000648 |
| Provider Name | Elizabeth Anne Mabry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194221820 PECOS PAC ID: 6406277201 Enrollment ID: I20210215000687 |
| Provider Name | Esther Toe-mcpherson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336562974 PECOS PAC ID: 7416289236 Enrollment ID: I20210819003247 |
| Provider Name | Mona Kaahu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033884275 PECOS PAC ID: 2062818461 Enrollment ID: I20210910000689 |
| Provider Name | Andrea Neita |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578778387 PECOS PAC ID: 7012016397 Enrollment ID: I20220908003138 |
| Provider Name | Sneha Innes |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1073650552 PECOS PAC ID: 6608243126 Enrollment ID: I20221111002075 |
| Provider Name | Benjamin White Allison |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306409305 PECOS PAC ID: 8729457320 Enrollment ID: I20221202001300 |
| Provider Name | Mary Lou Alonso |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578815783 PECOS PAC ID: 3173680543 Enrollment ID: I20221205000979 |
| Provider Name | Richard Jason Miller |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1508081266 PECOS PAC ID: 4789968405 Enrollment ID: I20221216001632 |
| Provider Name | Mischa Lorraine Fiske |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609571181 PECOS PAC ID: 5991160061 Enrollment ID: I20230424002260 |
| Provider Name | Samantha Ashley Gaffney |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1376236265 PECOS PAC ID: 5496118341 Enrollment ID: I20230825001199 |
| Provider Name | Kimberly Kristi Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316628860 PECOS PAC ID: 4183071509 Enrollment ID: I20231107001929 |
| Provider Name | Brooks Anthony Hunsaker |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1639857063 PECOS PAC ID: 0143679571 Enrollment ID: I20231211003512 |
| Provider Name | M Crystal Hill |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396797759 PECOS PAC ID: 1052382694 Enrollment ID: I20240208002616 |
Bogard Family And Sports Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 700 Sw Ramsey, Suite 104, Grants Pass, OR 97527 Phone: 541-471-4930 Fax: 541-471-1331 | |
James Lee Calvert M.d. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 181 Nw Bunnell Ave, Grants Pass, OR 97526 Phone: 541-479-4111 Fax: 541-955-1621 | |
Grants Pass Chiropractic Clinic, Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1103 Ne 7th St, Grants Pass, OR 97526 Phone: 541-479-1982 Fax: 541-479-0621 | |
Kurt A Brewster Md Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1601 Ne 6th Street, Grants Pass, OR 97526 Phone: 541-474-1020 Fax: 541-474-1108 | |
Mountainview Family Practice Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 741 Ne 6th St, Grants Pass, OR 97526 Phone: 541-471-2701 Fax: 541-471-1166 | |
Brian Hancock Md Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 841 Ne 7th St, Grants Pass, OR 97526 Phone: 541-474-2721 Fax: 541-474-0056 | |
Karen Joyce Hoskins Msn/fnp Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1100 Ne 7th St Ste C, Grants Pass, OR 97526 Phone: 541-476-7000 Fax: 541-476-7000 |