Provider Demographics
NPI:1861508632
Name:M. JAMIE MCALLISTER, D. O., P. C.
Entity Type:Organization
Organization Name:M. JAMIE MCALLISTER, D. O., P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MCALLISTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:541-330-9110
Mailing Address - Street 1:711 NE IRVING AVE.
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4738
Mailing Address - Country:US
Mailing Address - Phone:541-330-9110
Mailing Address - Fax:541-330-9112
Practice Address - Street 1:711 NE IRVING AVE.
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4738
Practice Address - Country:US
Practice Address - Phone:541-330-9110
Practice Address - Fax:541-330-9112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO17061207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C98282Medicare UPIN
ORR130689Medicare ID - Type Unspecified