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NPI Code Detail

MEDICARE: ADAPT

MEDICARE: ADAPT
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
1261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1184350811
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADAPT
Provider Business Mailing Address
First Line : PO BOX 1121
Second Line :
City : ROSEBURG
State : OR
Zip : 97470-0254
Country : US
Telephone Number : 541-492-4550
Fax Number : 541-492-0190
Provider Business Practice Location Address
First Line : 3005 NE DIAMOND LAKE BLVD STE 150
Second Line :
City : ROSEBURG
State : OR
Zip : 97470-3609
Country : US
Telephone Number : 541-492-4550
Fax Number : 541-492-0190
Authorized Official
Title or Position : COO
Name : MICHELLE MONET WATSON
Credential :
Telephone Number : 541-492-4550
Provider Enumeration Date : 07/26/2022
Last Update Date : 07/26/2022

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Directions to “ADAPT ” Practice Location

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