Organization
WINDING WATERS CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RENEE E GRANDI MD (PRES)
(541) 426-4502
Entity
Organization
Contact information
Practice address
603 MEDICAL PKWY, ENTERPRISE, OR 97828-5124
(541) 426-4502
(541) 426-6403
Mailing address
603 MEDICAL PKWY, ENTERPRISE, OR 97828-5124
(541) 426-4502
(541) 426-6403
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QR1300X
Rural Health Clinic/Center
Primary
383864
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
223198
—
OR
01
—
CG2920
RAILROAD MEDICARE
OR
01
—
OR01145
MEDICARE EMC SUBMITTER
OR
Enumeration date
08/23/2005
Last updated
06/29/2015
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