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NPI Code Detail

MEDICARE: THE CORVALLIS CLINIC AT NORTH ALBANY VILLAGE

MEDICARE: THE CORVALLIS CLINIC AT NORTH ALBANY VILLAGE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332900000XNon-Pharmacy Dispensing SiteMD28172OR

General Provider Information

NPI Number : 1073758157
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE CORVALLIS CLINIC AT NORTH ALBANY VILLAGE
Provider Business Mailing Address
First Line : 5810 NANCY RIDGE DR
Second Line : 100
City : SAN DIEGO
State : CA
Zip : 92121-2834
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 633 N ALBANY RD NW
Second Line :
City : ALBANY
State : OR
Zip : 97321-1433
Country : US
Telephone Number : 541-926-3441
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF OPERATIONS
Name : KENNY HEINE
Credential :
Telephone Number : 858-625-2990
Provider Enumeration Date : 12/03/2008
Last Update Date : 12/03/2018

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Directions to “THE CORVALLIS CLINIC AT NORTH ALBANY VILLAGE ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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