Provider Demographics
NPI:1992922595
Name:CREEKSIDE FAMILY MEDICINE, LLC
Entity type:Organization
Organization Name:CREEKSIDE FAMILY MEDICINE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-282-6580
Mailing Address - Street 1:749 GOLF VIEW DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9654
Mailing Address - Country:US
Mailing Address - Phone:541-282-6580
Mailing Address - Fax:541-326-0361
Practice Address - Street 1:749 GOLF VIEW DR UNIT A
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9654
Practice Address - Country:US
Practice Address - Phone:541-282-6580
Practice Address - Fax:541-326-0361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care