MEDICARE: 3C2MD, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	800230	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073510194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	3C2MD, INC.

Provider Business Mailing Address
First Line	:	1077 GATEWAY LOOP
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97477-1114
Country	:	US
Telephone Number	:	541-746-1020
Fax Number	:	541-284-7072

Provider Business Practice Location Address
First Line	:	601 EVERGREEN RD
Second Line	:
City	:	WOODBURN
State	:	OR
Zip	:	97071-2910
Country	:	US
Telephone Number	:	503-982-0111
Fax Number	:	503-982-2481

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. MARK GARBER
Credential	:
Telephone Number	:	541-746-1020

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	02/23/2015

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