Provider Demographics
NPI:1275641862
Name:MERLE WEST MEDICAL CENTER INC DBA
Entity Type:Organization
Organization Name:MERLE WEST MEDICAL CENTER INC DBA
Other - Org Name:WEST OCCUPATIONAL CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:RYBOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-883-6150
Mailing Address - Street 1:2633 CROSBY AVE
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-5777
Mailing Address - Country:US
Mailing Address - Phone:541-885-2666
Mailing Address - Fax:541-885-2618
Practice Address - Street 1:2633 CROSBY AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-5777
Practice Address - Country:US
Practice Address - Phone:541-885-2666
Practice Address - Fax:541-885-2618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0700001687261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR05957500OtherBCBS REENCE
OR152371Medicaid
ORH1814 04OtherPACIFIC SOURCE HEALTH PLA