ASHLAND INTEGRATIVE CARE PC NPI 1659429249

NPI Information

NPI: 1659429249
Provider Name: ASHLAND INTEGRATIVE CARE PC
Classification: Nurse Practitioner - 363LP0808X
Entity Type: Organization

Specialization: Psychiatric/Mental Health

CLIA Number: 38D2077509

Address:
850 SISKIYOU BLVD
SUITE 1
ASHLAND, OR
ZIP 97520
Phone: (541) 201-3173
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ASHLAND INTEGRATIVE CARE PC is a psychiatric/mental health nurse practitioner in Ashland, OR. ASHLAND INTEGRATIVE CARE PC NPI is 1659429249. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

850 SISKIYOU BLVD
SUITE 1
ASHLAND, OR
ZIP 97520-125
Phone: (541) 201-3173
Fax: (561) 427-1393

The provider's authorized official is Joann Ellen Gruber .
The authorized official title is President and has the following contact phone number (541) 201-3173.

The CLIA number assigned to this NPI record is 38D2077509 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/8/2007 and was last updated on 8/11/2015.

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	201050217	OREGON	No
2	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	201050218	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	500685278	MEDICAID	OREGON
2	R181124	MEDICARE PIN	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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