Organization
PAULINA PEAK FAMILY HEALTHCARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY L MILLER (ADMINISTRATOR)
(541) 536-8060
Entity
Organization
Contact information
Practice address
51384 HIGHWAY 97, LA PINE, OR 97739-9871
(541) 536-8060
Mailing address
PO BOX 3389, LA PINE, OR 97739-3389
(541) 536-8060
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
200250124NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DD9066
RAILROAD MEDICARE
OR
Enumeration date
12/11/2006
Last updated
10/24/2012
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