Provider Demographics
NPI:1417146549
Name:MIDDLE WAY HEALTH CARE LLC
Entity Type:Organization
Organization Name:MIDDLE WAY HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER/ FNP
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:KENDALL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:530-812-7367
Mailing Address - Street 1:2615 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TILLAMOOK
Mailing Address - State:OR
Mailing Address - Zip Code:97141-4114
Mailing Address - Country:US
Mailing Address - Phone:503-842-4809
Mailing Address - Fax:503-842-8022
Practice Address - Street 1:2615 6TH ST
Practice Address - Street 2:
Practice Address - City:TILLAMOOK
Practice Address - State:OR
Practice Address - Zip Code:97141-4114
Practice Address - Country:US
Practice Address - Phone:503-812-7367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR094006492N1261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1245291756OtherNPI FOR LISA KENDALL FNP
OR218477Medicaid