| NPI | 1992354567 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BOBBI JOLYNE SURPLUS Revenue Cycle Manager 541-408-9486 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2019-09-06 |
| Last Update Date | 2019-09-06 |