Organization
WINDING WATERS MEDICAL CLINIC
Active
Other names
Open Space
Organization subpart
No
Provider details
NPI number
Authorized official
KELI JEAN DENNIS (COO)
(541) 426-4502
Entity
Organization
Contact information
Practice address
758 NW 1ST ST, ENTERPRISE, OR 97828-1527
(541) 426-4502
Mailing address
603 MEDICAL PKWY, ENTERPRISE, OR 97828-5124
(541) 426-4502
(541) 426-6403
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
03/19/2019
Last updated
09/12/2023
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