Organization
WINDING WATERS CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCOTT K SIEBE MD (PRESIDENT)
(541) 886-2431
Entity
Organization
Contact information
Practice address
203 E FIRST STREET, WALLOWA, OR 97885-9999
(541) 886-2431
(541) 886-2211
Mailing address
406 NE 1ST ST, ENTERPRISE, OR 97828-1168
(541) 886-2431
(541) 886-2211
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QR1300X
Rural Health Clinic/Center
Primary
383865
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
223198
—
OR
01
—
5966000
BCBS PROVIDER NUMBER
OR
01
—
CG2920
MEDICARE RAILROAD
OR
Enumeration date
04/13/2007
Last updated
07/08/2008
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