Healthcare Provider Details

I. General information

NPI: 1649660762
Provider Name (Legal Business Name): JAMES BARTIK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 11/04/2022
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 CLEAR VUE LN
SPRINGFIELD OR
97477-1373
US

IV. Provider business mailing address

3587 HEATHROW WAY
MEDFORD OR
97504-4004
US

V. Phone/Fax

Practice location:
  • Phone: 541-505-8558
  • Fax: 541-735-3946
Mailing address:
  • Phone: 541-858-8170
  • Fax: 541-858-8167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: