Healthcare Provider Details

I. General information

NPI: 1558766121
Provider Name (Legal Business Name): ANIMAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2014
Last Update Date: 10/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 N SANTIAM HWY
LEBANON OR
97355-4342
US

IV. Provider business mailing address

185 N SANTIAM HWY
LEBANON OR
97355-4342
US

V. Phone/Fax

Practice location:
  • Phone: 541-451-1319
  • Fax: 541-451-1028
Mailing address:
  • Phone: 541-451-1319
  • Fax: 541-451-1028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number4122
License Number StateOR

VIII. Authorized Official

Name: DR. STEVEN L HIETT
Title or Position: VETERINARIAN
Credential: DVM
Phone: 541-451-1319