Provider Demographics
NPI:1730286709
Name:DIABETES AND ENDOCRINOLOGY CLINIC PC
Entity Type:Organization
Organization Name:DIABETES AND ENDOCRINOLOGY CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-460-0222
Mailing Address - Street 1:63172 DESERT SAGE ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7529
Mailing Address - Country:US
Mailing Address - Phone:541-326-9448
Mailing Address - Fax:
Practice Address - Street 1:63172 DESERT SAGE ST.
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7529
Practice Address - Country:US
Practice Address - Phone:541-460-0222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD13438174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR121319Medicaid
OR121319Medicaid
OR111843Medicare ID - Type Unspecified