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NPI Code Detail

MEDICARE: JEFFREY CARRELL

MEDICARE: JEFFREY CARRELL
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1396113957
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY CARRELL
Provider Business Mailing Address
First Line : 207 W 3RD ST
Second Line :
City : THE DALLES
State : OR
Zip : 97058-1734
Country : US
Telephone Number : 541-296-5452
Fax Number : 541-296-5263
Provider Business Practice Location Address
First Line : 3601 W 10TH ST
Second Line :
City : THE DALLES
State : OR
Zip : 97058-4377
Country : US
Telephone Number : 541-296-5452
Fax Number : 541-296-2731
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2015
Last Update Date : 09/11/2015

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Directions to “ JEFFREY CARRELL ” Practice Location

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