Edward Frazier Sirchuk Sr.
Individual provider Active NPI Peer Specialist · Harbor, OR
NPI 1851107635 · NPPES record last updated Dec 7, 2024
Key facts
- NPI
- 1851107635
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Peer Specialist 175T00000X
- Practice address
- 15957 Highway 101 S Ste 11
Harbor, OR 97415-8507 - Phone
- (541) 813-9142
- NPI assigned
- Dec 6, 2024
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| PACE Provider Organization | 251T00000X | |||
| Peer Specialist | 175T00000X | Yes |
Addresses
Primary practice location
15957 Highway 101 S Ste 11
Harbor, OR 97415-8507
Mailing address
General Delivery
Harbor, OR 97415-9999
Phone (541) 813-9142
Other providers in Harbor, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 7, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.