| Ventana Wellness, Pc | |
|
3156 State Street Medford OR 97504-8450 | |
| (541) 773-9772 | |
| (541) 773-1113 |
| Full Name | Ventana Wellness, Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 3156 State Street, Medford, Oregon |
| Authorized Official Name and Position | Frank Richard Noodleman (OWNER) |
| Authorized Official Contact | 5417739772 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ventana Wellness, Pc 3156 State Street Medford OR 97504-8450 Ph: (541) 773-9772 | Ventana Wellness, Pc 3156 State Street Medford OR 97504-8450 Ph: (541) 773-9772 |
| NPI Number | 1720012339 |
|---|---|
| Provider Enumeration Date | 07/10/2006 |
| Last Update Date | 11/16/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720012339 | NPI | - | NPPES |
| 287179 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 06-00024661 (Oregon) | Primary |
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