Organization
OBSIDIAN URGENT CARE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL J LEONE F.N.P. (PRESIDENT)
(541) 962-7407
Entity
Organization
Contact information
Practice address
401 ADAMS AVE, LA GRANDE, OR 97850-1619
(541) 962-7407
(541) 962-7479
Mailing address
401 ADAMS AVE, LA GRANDE, OR 97850-1619
(541) 962-7407
(541) 962-7479
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
087000017N1 FNP-PP
OR
363LF0000X
Family Nurse Practitioner
200050027NP-FNP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
118286
—
OR
01
—
831550000
GROUP NUMBER FOR BCBS
OR
01
—
931176109
GROUP NUMBER FOR ALL OTH
OR
Enumeration date
01/03/2007
Last updated
09/04/2008
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