Wild Rose Medical Clinic PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

16009 Issued in OR

Legal business name

WILD ROSE MEDICAL CLINIC PC

Practice address

401 E 10TH Ave
Suite 250
Eugene, OR 97401-3317

Phone

(541) 686-4153

Fax

(541) 686-3468

NPI assigned

Jan 8, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kathleen Cordes, MD

Title

President

Phone

(541) 686-4153

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191974400000",
    "number": "1083762637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 E 10TH AVE",
            "address_2": "SUITE 250",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974013317",
            "telephone_number": "541-686-4153",
            "fax_number": "541-686-3468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 E 10TH AVE",
            "address_2": "SUITE 250",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974013317",
            "telephone_number": "541-686-4153",
            "fax_number": "541-686-3468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILD ROSE MEDICAL CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2007-10-10",
        "status": "A",
        "authorized_official_last_name": "CORDES",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "541-686-4153",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "16009",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "072173",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carlyn Mei-Lan Wierda, LMFT
• Chris Wig, M.S., B.A.
• Jennifer Wig, MS
• Karen Marie Wilbrecht
• Kara Noel Wilcox, PA-C
• Justin W Wilde
• Eryn Grace Wilder
• Kaseja Laurine Wilder, LCSW
• Kestrel Wilder, LMT
• Payton Wilder

• Family Medicine Physician in Eugene, OR
• Providers in Eugene, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.