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General NPI Number Information
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NPI Number | 1134993058
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Entity Type | Organization
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Legal Business Name | J BEVERLY ENTERPRISES, LLC
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Dates
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Enumeration Date | 11/10/2023
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Last Update Date | 11/10/2023
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Provider Practice Location Address
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Address Line | 1110 18TH ST STE 6
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City | SPRINGFIELD
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State | OR
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Zip | 97477-4200
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Country | US
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Telephone | 541-517-3970
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Fax | 458-201-8188
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Provider Business Mailing Address
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Address Line | 2329 RODNEY CT
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City | SPRINGFIELD
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State | OR
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Zip | 97477-1964
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Country | US
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Telephone | 805-440-8341
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAMIE BEVERLY
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Credential |
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Telephone | 541-517-3970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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