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General NPI Number Information
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NPI Number | 1215022298
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Entity Type | Organization
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Legal Business Name | OREGON URGENT CARE
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3232 NAVARRE
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City | OREGON
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State | OH
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Zip | 41616-7074
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Country | US
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Telephone | 419-691-0636
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Fax | 419-693-1412
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Provider Business Mailing Address
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Address Line | 3232 NAVARRE
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City | OREGON
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State | OH
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Zip | 41616-7074
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Country | US
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Telephone | 419-691-0636
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Fax | 419-693-1412
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACK G SIEBENALER II
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Credential | M.D.
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Telephone | 419-691-0636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 35053850S
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License Number State | OH
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