Healthcare Provider Details

I. General information

NPI: 1235666272
Provider Name (Legal Business Name): MY DIRECT HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 TWIN CREEKS CROSSING LOOP SUITE A
CENTRAL POINT OR
97502-8661
US

IV. Provider business mailing address

700 TWIN CREEKS CROSSING LOOP SUITE A
CENTRAL POINT OR
97502-8661
US

V. Phone/Fax

Practice location:
  • Phone: 541-500-0561
  • Fax: 541-982-7287
Mailing address:
  • Phone: 541-500-0561
  • Fax: 541-225-4874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number201500076NP-PP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LAURIE B DAHL
Title or Position: OWNER/NURSE PRACTITIONER
Credential: NP
Phone: 541-500-0561