Provider Demographics
NPI:1275576159
Name:ALSEA RURAL HEALTH CARE, INC.
Entity Type:Organization
Organization Name:ALSEA RURAL HEALTH CARE, INC.
Other - Org Name:ALSEA CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:541-487-7116
Mailing Address - Street 1:435 E. ALDER ST.
Mailing Address - Street 2:PO BOX 229
Mailing Address - City:ALSEA
Mailing Address - State:OR
Mailing Address - Zip Code:97324-0229
Mailing Address - Country:US
Mailing Address - Phone:541-487-7116
Mailing Address - Fax:541-487-4076
Practice Address - Street 1:201 N. 4TH ST.
Practice Address - Street 2:
Practice Address - City:ALSEA
Practice Address - State:OR
Practice Address - Zip Code:97324-0229
Practice Address - Country:US
Practice Address - Phone:541-487-7116
Practice Address - Fax:541-487-4076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR267872Medicaid
OR383807Medicare ID - Type UnspecifiedRURAL HEALTH CLINIC