Provider Demographics
NPI:1568568707
Name:MB HEALTHCARE ASSOCIATES INC
Entity Type:Organization
Organization Name:MB HEALTHCARE ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:1/2 OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGUERITE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:NP-C
Authorized Official - Phone:541-779-5877
Mailing Address - Street 1:PO BOX 965
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-0069
Mailing Address - Country:US
Mailing Address - Phone:541-779-5877
Mailing Address - Fax:541-664-3287
Practice Address - Street 1:33 N CENTRAL AVE
Practice Address - Street 2:SUITE 425
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-5900
Practice Address - Country:US
Practice Address - Phone:541-779-5877
Practice Address - Fax:541-664-3287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR79042695174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR240508Medicaid
OR240508Medicaid