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General NPI Number Information
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NPI Number | 1417146549
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Entity Type | Organization
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Legal Business Name | MIDDLE WAY HEALTH CARE LLC
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Dates
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Enumeration Date | 10/15/2007
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 2615 6TH ST
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City | TILLAMOOK
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State | OR
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Zip | 97141-4114
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Country | US
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Telephone | 503-812-7367
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Fax |
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Provider Business Mailing Address
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Address Line | 2615 6TH ST
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City | TILLAMOOK
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State | OR
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Zip | 97141-4114
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Country | US
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Telephone | 503-842-4809
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Fax | 503-842-8022
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Authorized Official
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Title or Position | BOARD MEMBER/ FNP
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Name | MS. LISA JOY KENDALL
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Credential | FNP
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Telephone | 530-812-7367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 094006492N1
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License Number State | OR
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