Provider Demographics
NPI:1083665681
Name:LAPINE COMMUNITY CLINIC, LLC
Entity Type:Organization
Organization Name:LAPINE COMMUNITY CLINIC, LLC
Other - Org Name:STEFFEY, LISA SOLE MEMBER
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHANCE
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:STEFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-536-3435
Mailing Address - Street 1:PO BOX 3300
Mailing Address - Street 2:
Mailing Address - City:LA PINE
Mailing Address - State:OR
Mailing Address - Zip Code:97739-3300
Mailing Address - Country:US
Mailing Address - Phone:541-536-3435
Mailing Address - Fax:541-536-8047
Practice Address - Street 1:51600 S HUNTINGTON RD
Practice Address - Street 2:
Practice Address - City:LA PINE
Practice Address - State:OR
Practice Address - Zip Code:97739-9626
Practice Address - Country:US
Practice Address - Phone:541-536-3435
Practice Address - Fax:541-536-8047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227605Medicaid
OR227605Medicaid
OR383844Medicare ID - Type UnspecifiedRHC PROVIDER NUMBER