Healthcare Provider Details

I. General information

NPI: 1871877506
Provider Name (Legal Business Name): ROBERTA G BELICH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROBERTA L GARVEY PA-C

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

384 SE COMBS FLAT RD STE 1200
PRINEVILLE OR
97754-2562
US

IV. Provider business mailing address

2500 NE NEFF RD
BEND OR
97701-6015
US

V. Phone/Fax

Practice location:
  • Phone: 541-447-6263
  • Fax: 541-447-8724
Mailing address:
  • Phone: 541-382-4321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA54007
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA156554
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: