| Wild Rose Medical Clinic PC | |
|
401 E 10th Ave Suite 250 Eugene OR 97401-3317 | |
| (541) 686-4153 | |
| (541) 686-3468 |
| Full Name | Wild Rose Medical Clinic PC |
|---|---|
| Speciality | Family Medicine |
| Location | 401 E 10th Ave, Eugene, Oregon |
| Authorized Official Name and Position | Kathleen Cordes (PRESIDENT) |
| Authorized Official Contact | 5416864153 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wild Rose Medical Clinic PC 401 E 10th Ave Suite 250 Eugene OR 97401-3317 Ph: (541) 686-4153 | Wild Rose Medical Clinic PC 401 E 10th Ave Suite 250 Eugene OR 97401-3317 Ph: (541) 686-4153 |
| NPI Number | 1083762637 |
|---|---|
| Provider Enumeration Date | 01/08/2007 |
| Last Update Date | 10/10/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083762637 | NPI | - | NPPES |
| 072173 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 16009 (Oregon) | Primary |
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