MEDICARE: ONE FAMILY MEDICAL GROUP LLC

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1174190961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONE FAMILY MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	1585 NW WASHINGTON BLVD
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-1049
Country	:	US
Telephone Number	:	541-474-5511
Fax Number	:	541-472-3225

Provider Business Practice Location Address
First Line	:	1585 NW WASHINGTON BLVD
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-1049
Country	:	US
Telephone Number	:	541-474-5511
Fax Number	:	541-472-3225

Authorized Official
Title or Position	:	FAMILY NURSE PRACTIOITIONER
Name	:	TORI RUMREY
Credential	:	NPC
Telephone Number	:	541-474-5511

Provider Enumeration Date	:	06/09/2021
Last Update Date	:	06/09/2021

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