Provider Demographics
NPI:1215022298
Name:OREGON URGENT CARE
Entity Type:Organization
Organization Name:OREGON URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:G
Authorized Official - Last Name:SIEBENALER
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:419-691-0636
Mailing Address - Street 1:3232 NAVARRE
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:41616-7074
Mailing Address - Country:US
Mailing Address - Phone:419-691-0636
Mailing Address - Fax:419-693-1412
Practice Address - Street 1:3232 NAVARRE
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:41616-7074
Practice Address - Country:US
Practice Address - Phone:419-691-0636
Practice Address - Fax:419-693-1412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053850S261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0636539Medicaid
OH0636539Medicaid
OHJA9229351Medicare ID - Type Unspecified