MEDICARE: RICHARD HINDMARSH M.D.

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
1	207RA0401X	Addiction Medicine (Internal Medicine) Physician	MD26221	OR

General Provider Information

NPI Number	:	1316948862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD HINDMARSH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1193
Second Line	:
City	:	CORVALLIS
State	:	OR
Zip	:	97339-1193
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 MULLINS DR STE C1
Second Line	:
City	:	LEBANON
State	:	OR
Zip	:	97355-2868
Country	:	US
Telephone Number	:	541-451-7450
Fax Number	:	541-451-7454

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	11/10/2020

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