Organization
MERLE WEST MEDICAL CENTER INC DBA
Active
Other names
West Occupational Care Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN ANDREW RYBOLT (CHIEF FINANCIAL OFFICER)
(541) 883-6150
Entity
Organization
Contact information
Practice address
2633 CROSBY AVE, KLAMATH FALLS, OR 97603-5777
(541) 885-2666
(541) 885-2618
Mailing address
2633 CROSBY AVE, KLAMATH FALLS, OR 97603-5777
(541) 885-2666
(541) 885-2618
Taxonomy
Speciality
Code
Description
License number
State
261QX0100X
Occupational Medicine Clinic/Center
Primary
0700001687
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05957500
BCBS REENCE
OR
05
—
152371
—
OR
01
—
H1814 04
PACIFIC SOURCE HEALTH PLA
OR
Enumeration date
08/25/2006
Last updated
08/22/2020
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