Provider Demographics
NPI:1366036238
Name:OLIVE TREE MEDICAL CARE, LLC
Entity Type:Organization
Organization Name:OLIVE TREE MEDICAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:MARCHESSAULT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:541-887-2200
Mailing Address - Street 1:1803B MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-2636
Mailing Address - Country:US
Mailing Address - Phone:541-887-2200
Mailing Address - Fax:541-887-2011
Practice Address - Street 1:1803 MAIN ST # B
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-2636
Practice Address - Country:US
Practice Address - Phone:541-887-2200
Practice Address - Fax:541-887-2011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care