MEDICARE: LISA MICHELLE CALLAHAN

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	261QP2300X	Primary Care Clinic/Center	94000382N2	OR

General Provider Information

NPI Number	:	1588739130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LISA MICHELLE CALLAHAN

Provider Business Mailing Address
First Line	:	1601 NE 6TH ST
Second Line	:	SUITE B
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-1035
Country	:	US
Telephone Number	:	541-472-0021
Fax Number	:	541-476-4003

Provider Business Practice Location Address
First Line	:	1601 NE 6TH ST
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-1035
Country	:	US
Telephone Number	:	541-476-3636
Fax Number	:	541-474-4628

Authorized Official
Title or Position	:	OWNER
Name	:	LISA MICHELLE CALLAHAN
Credential	:	CPNP
Telephone Number	:	541-472-0021

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	10/12/2016

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Directions to “LISA MICHELLE CALLAHAN ” Practice Location

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