=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942925326
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRAXIS HEALTH, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2022
-----------------------------------------------------
Last Update Date | 10/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 531 SE CLAY ST
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97338-2865
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 971-612-6100
-----------------------------------------------------
Fax | 971-612-6101
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1517
-----------------------------------------------------
City | PENDLETON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97801-0410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-708-1119
-----------------------------------------------------
Fax | 541-278-8349
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REVENUE CYCLE DIRECTOR
-----------------------------------------------------
Name | JESSICA M REAGAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 541-966-6136
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------