Organization
MOSAIC MEDICAL
Active
Parent organization
MOSAIC MEDICAL
Other names
Mosaic Medical Prineville
Organization subpart
Yes
Provider details
NPI number
Legal business name
MOSAIC MEDICAL
Authorized official
MEGAN HAASE FNP (CEO)
(541) 447-0707
Entity
Organization
Contact information
Practice address
375 NW BEAVER ST, SUITE 101, PRINEVILLE, OR 97754-1802
(541) 447-0707
(541) 383-1883
Mailing address
600 SW COLUMBIA ST, SUITE 6210, BEND, OR 97702-1099
(541) 447-0707
(541) 447-0708
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
182960
—
OR
Enumeration date
01/22/2013
Last updated
04/19/2016
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