| Wellspring Family Practice | |
|
1716 Williams Hwy Grants Pass OR 97527-5661 | |
| (541) 474-6053 | |
| Not Available |
| Full Name | Wellspring Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 1716 Williams Hwy, Grants Pass, Oregon |
| Authorized Official Name and Position | Jon Ermshar (PRESIDENT/PROVIDER) |
| Authorized Official Contact | 5414746053 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellspring Family Practice 1208 Beall Ln Central Point OR 97502-1573 Ph: (541) 664-5151 | Wellspring Family Practice 1716 Williams Hwy Grants Pass OR 97527-5661 Ph: (541) 474-6053 |
| NPI Number | 1366492548 |
|---|---|
| Provider Enumeration Date | 05/11/2006 |
| Last Update Date | 11/26/2007 |
| Medicare PECOS PAC ID | 0345142451 |
|---|---|
| Medicare Enrollment ID | O20040121000126 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366492548 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Jon E L Ermshar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366438095 PECOS PAC ID: 4880596998 Enrollment ID: I20040407000218 |
| Provider Name | Gail F Giltner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558413856 PECOS PAC ID: 0648324947 Enrollment ID: I20090821000027 |
| Provider Name | Mckenzie L Myers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568869279 PECOS PAC ID: 1658545355 Enrollment ID: I20150321000070 |
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