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General NPI Number Information
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NPI Number | 1780287342
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Entity Type | Organization
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Legal Business Name | BEAR VALLEY MEDICAL CLINIC
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Dates
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Enumeration Date | 11/17/2020
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Last Update Date | 12/15/2020
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Provider Practice Location Address
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Address Line | 1833 NEBRASKA AVE
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City | GRANTS PASS
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State | OR
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Zip | 97527-5701
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Country | US
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Telephone | 541-226-9840
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Fax |
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Provider Business Mailing Address
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Address Line | 1833 NEBRASKA AVE
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City | GRANTS PASS
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State | OR
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Zip | 97527-5701
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Country | US
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Telephone | 541-226-9840
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Fax |
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Authorized Official
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Title or Position | CLINIC MANAGER
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Name | CHERIE TIBBITS
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Credential |
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Telephone | 541-821-3522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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