Healthcare Provider Details

I. General information

NPI: 1750380440
Provider Name (Legal Business Name): JOHNSON & CADE FAMILY PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2088 NE KIM LN STE A
BEND OR
97701-6588
US

IV. Provider business mailing address

2088 NE KIM LN STE A
BEND OR
97701-6588
US

V. Phone/Fax

Practice location:
  • Phone: 541-389-4600
  • Fax: 541-312-9600
Mailing address:
  • Phone: 541-389-4600
  • Fax: 541-312-9600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateOR

VIII. Authorized Official

Name: MRS. TERRI KAY DUNSCOMB
Title or Position: OFFICE MANAGER
Credential:
Phone: 541-389-4600