# MOSAIC MEDICAL

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MOSAIC MEDICAL
- **Other names:** Mosaic Pharmacy-Madras
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1730830365
- **Legal business name:** MOSAIC MEDICAL
- **Authorized official:** BOBBI JOLYNE SURPLUS (REVENUE CYCLE MANAGER)
- **Authorized official phone:** (541) 408-9486

## Contact information

- **Practice address:** 500 NE A ST STE 101, MADRAS, OR 97741-1842
- **Practice address phone:** (541) 383-3005
- **Practice address fax:** (541) 383-1883
- **Mailing address:** 600 SW COLUMBIA ST STE 6150, BEND, OR 97702-1099
- **Mailing address phone:** (541) 383-3005
- **Mailing address fax:** (541) 383-1883

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 01/14/2022
- **Last updated:** 01/14/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0003755 | PHARMACY BOARD | OR |