Organization
NORTH LAKE CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUCE D CARLSON M.D. (OWNER)
(541) 576-2343
Entity
Organization
Contact information
Practice address
87520 BAY RD, CHRISTMAS VALLEY, OR 97641-0377
(541) 576-2343
(541) 576-2869
Mailing address
PO BOX 377, CHRISTMAS VALLEY, OR 97641-0377
(541) 576-2343
(541) 576-2869
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
MD07786
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080385000
BCBS OF OREGON
—
05
—
182817
—
OR
Enumeration date
05/19/2009
Last updated
05/19/2009
Update your record
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