Provider Demographics
NPI:1508190661
Name:PPC GROUP LLC
Entity Type:Organization
Organization Name:PPC GROUP LLC
Other - Org Name:PREVENTION PLUS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:ERDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-726-1865
Mailing Address - Street 1:1800 CENTENNIAL BLVD
Mailing Address - Street 2:6
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-4385
Mailing Address - Country:US
Mailing Address - Phone:541-726-2179
Mailing Address - Fax:
Practice Address - Street 1:1800 CENTENNIAL BLVD
Practice Address - Street 2:SUITE #6
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-4385
Practice Address - Country:US
Practice Address - Phone:541-726-2179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23479261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care