OBSIDIAN URGENT CARE PC NPI 1255498473

NPI Information

NPI: 1255498473
Provider Name: OBSIDIAN URGENT CARE, PC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

Address:
401 ADAMS AVE
LA GRANDE, OR
ZIP 97850
Phone: (541) 962-7407
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OBSIDIAN URGENT CARE, PC is a family nurse practitioner in La Grande, OR. OBSIDIAN URGENT CARE, PC NPI is 1255498473. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

401 ADAMS AVE
LA GRANDE, OR
ZIP 97850-619
Phone: (541) 962-7407
Fax: (541) 962-7479

The provider's authorized official is Daniel J Leone .
The authorized official title is President and has the following contact phone number (541) 962-7407.

The enumeration date for this NPI number is 1/3/2007 and was last updated on 9/4/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	200050027NP-FNP-PP	OREGON	No
2	363LF0000X	Nurse Practitioner	Family	087000017N1 FNP-PP	OREGON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	831550000	OTHER	OREGON	GROUP NUMBER FOR BCBS
2	R121473	MEDICARE PIN	OREGON
3	931176109	OTHER	OREGON	GROUP NUMBER FOR ALL OTH
4	R83634	MEDICARE UPIN	OREGON
5	118286	MEDICAID	OREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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