Provider Demographics
NPI:1376164749
Name:LAST FRONTIER HEALTHCARE DISTRICT
Entity Type:Organization
Organization Name:LAST FRONTIER HEALTHCARE DISTRICT
Other - Org Name:CANBY FAMILY PRACTICE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-708-8801
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:ALTURAS
Mailing Address - State:CA
Mailing Address - Zip Code:96101-0190
Mailing Address - Country:US
Mailing Address - Phone:530-708-8801
Mailing Address - Fax:530-233-6609
Practice Address - Street 1:670 COUNTY ROAD 83
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:CA
Practice Address - Zip Code:96015-9722
Practice Address - Country:US
Practice Address - Phone:530-233-4641
Practice Address - Fax:530-233-2830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-27
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health