Organization
PINE EAGLE HEALTH PLANNING COMMITTEE
Active
Other names
DBA-Pine Eagle Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
TERRA JEAN LEWIS (ADMINISTRATOR)
(541) 742-5024
Entity
Organization
Contact information
Practice address
218 NORTH PINE STREET, HALFWAY, OR 97834
(541) 742-5023
(541) 742-7210
Mailing address
P.O. BOX 647, HALFWAY, OR 97834
(541) 742-5023
(541) 742-7210
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
383869
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
009919000
BLUE CROSS BLUE SHIELD
OR
05
—
025069
—
OR
01
—
R139059
MEDICARE B
OR
Enumeration date
09/11/2006
Last updated
06/17/2020
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