Healthcare Provider Details

I. General information

NPI: 1285849042
Provider Name (Legal Business Name): CENTRAL OREGON FAMILY MEDICINE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 NW 4TH
REDMOND OR
97756
US

IV. Provider business mailing address

PO BOX 460
REDMOND OR
97756
US

V. Phone/Fax

Practice location:
  • Phone: 541-923-0119
  • Fax: 541-923-3228
Mailing address:
  • Phone: 541-923-0119
  • Fax: 541-923-3228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberMD21301
License Number StateOR

VIII. Authorized Official

Name: MARK J HUGHES
Title or Position: PRESIDENT
Credential: DO
Phone: 541-923-0119