Provider Demographics
NPI:1225865876
Name:LA PINE COMMUNITY HEALTH CENTER
Entity type:Organization
Organization Name:LA PINE COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-536-3435
Mailing Address - Street 1:51600 HUNTINGTON RD # 101
Mailing Address - Street 2:
Mailing Address - City:LA PINE
Mailing Address - State:OR
Mailing Address - Zip Code:97739-8887
Mailing Address - Country:US
Mailing Address - Phone:541-536-3435
Mailing Address - Fax:541-536-1040
Practice Address - Street 1:51615 BLUEWOOD AVE STE 120
Practice Address - Street 2:
Practice Address - City:LA PINE
Practice Address - State:OR
Practice Address - Zip Code:97739-9211
Practice Address - Country:US
Practice Address - Phone:541-536-3435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-17
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography