Provider Demographics
NPI:1134472582
Name:WHOLE PERSON CARE FAMILY PRACTICE
Entity Type:Organization
Organization Name:WHOLE PERSON CARE FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:C
Authorized Official - Last Name:HEIDINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-850-7697
Mailing Address - Street 1:2301 MOUNTAINVIEW BLVD. STE B
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601
Mailing Address - Country:US
Mailing Address - Phone:541-850-7697
Mailing Address - Fax:541-884-1580
Practice Address - Street 1:2301 MOUNTAINVIEW BLVD. STE B
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601
Practice Address - Country:US
Practice Address - Phone:541-850-7697
Practice Address - Fax:541-884-1580
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHOLE PERSON CARE FAMILY PRACTICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMP18680207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty