Healthcare Provider Details

I. General information

NPI: 1003732900
Provider Name (Legal Business Name): GOOD HEALTH DIRECT PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 E JACKSON ST STE A
MEDFORD OR
97504-6011
US

IV. Provider business mailing address

3377 SNOWY BUTTE LN
CENTRAL POINT OR
97502-1561
US

V. Phone/Fax

Practice location:
  • Phone: 541-414-7512
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. CONSUELO BARTYZAL
Title or Position: OWNER
Credential: FNP
Phone: 541-414-7512