Provider Demographics
NPI:1467746065
Name:HOUSE CALL DOC LLC
Entity Type:Organization
Organization Name:HOUSE CALL DOC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:HUNT
Authorized Official - Last Name:WALDRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-740-3340
Mailing Address - Street 1:2610 NW GLENWOOD DR
Mailing Address - Street 2:HOUSE CALL DOC, LLC
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3134
Mailing Address - Country:US
Mailing Address - Phone:541-740-3340
Mailing Address - Fax:541-207-3520
Practice Address - Street 1:2610 NW GLENWOOD DR
Practice Address - Street 2:HOUSE CALL DOC, LLC
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3134
Practice Address - Country:US
Practice Address - Phone:541-740-3340
Practice Address - Fax:541-207-3520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17598261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care