Provider Demographics
NPI:1346218252
Name:KLAMATH WALK IN CARE CENTER INC.
Entity Type:Organization
Organization Name:KLAMATH WALK IN CARE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PUFFENBARGER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:541-882-2118
Mailing Address - Street 1:2655 SHASTA WAY
Mailing Address - Street 2:SUITE #7
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-4455
Mailing Address - Country:US
Mailing Address - Phone:541-882-2118
Mailing Address - Fax:541-882-0617
Practice Address - Street 1:2655 SHASTA WAY
Practice Address - Street 2:SUITE #7
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-4455
Practice Address - Country:US
Practice Address - Phone:541-882-2118
Practice Address - Fax:541-882-0617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR277731Medicaid
ORS04353Medicare UPIN
OR0000WFBRPMedicare PIN