Bear Valley Medical Clinic
Organization Active NPI Nurse Practitioner · Grants Pass, OR
NPI 1780287342 · NPPES record last updated Dec 15, 2020
Key facts
- NPI
- 1780287342
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nurse Practitioner 363L00000X
- Legal business name
- BEAR VALLEY MEDICAL CLINIC
- Practice address
- 1833 Nebraska Ave
Grants Pass, OR 97527-5701 - Phone
- (541) 226-9840
- NPI assigned
- Nov 17, 2020
- Organization subpart
- No
Authorized official
- Name
- Cherie Tibbits
- Title
- Clinic Manager
- Phone
- (541) 821-3522
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20201223002325 | OR | Part B Supplier - Clinic/Group Practice | 3072925627 |
Receives reassigned benefits from 1 practitioner Practice locations: Grants Pass, OR |
National Provider Directory
Locations
1690 NE Lynda Ln
Grants Pass, OR 97526
Phone (541) 226-9840
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner |
363L00000X | Yes |
Addresses
Primary practice location
1833 Nebraska Ave
Grants Pass, OR 97527-5701
Mailing address
1833 Nebraska Ave
Grants Pass, OR 97527-5701
Phone (541) 226-9840
Other providers in Grants Pass, OR
- Jarrod Carl Baxter
- BD Grants Pass I LLC
- BD Grants Pass II LLC
- Linford Shenk Beachy
- Kristi Bean
- Joanne Beatty
- Kelli Beaumont
- Sara Christine Beck
- Tani Janna Becker
- Daniel Ellis Bedford
All providers in Grants Pass, OR · Nurse Practitioner in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 15, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.