Provider Demographics
NPI:1437187614
Name:REDMOND IMMEDIATE HEALTH CARE LLC
Entity Type:Organization
Organization Name:REDMOND IMMEDIATE HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHERREL
Authorized Official - Middle Name:A
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-923-4576
Mailing Address - Street 1:PO BOX 1770
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-0519
Mailing Address - Country:US
Mailing Address - Phone:541-923-4576
Mailing Address - Fax:541-923-4976
Practice Address - Street 1:3818 SW 21ST PL
Practice Address - Street 2:SUITE 100
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-7771
Practice Address - Country:US
Practice Address - Phone:541-548-2899
Practice Address - Fax:541-504-3781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR120083Medicare PIN