Provider Demographics
NPI:1891397931
Name:GO GENTLY MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:GO GENTLY MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATIONAL DIR OF PAYER CONTRACTS
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:E
Authorized Official - Last Name:FEDJUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-325-6181
Mailing Address - Street 1:10365 SE SUNNYSIDE RD STE 340
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5751
Mailing Address - Country:US
Mailing Address - Phone:503-698-9811
Mailing Address - Fax:503-698-8988
Practice Address - Street 1:10365 SE SUNNYSIDE RD STE 340
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5751
Practice Address - Country:US
Practice Address - Phone:503-698-9811
Practice Address - Fax:503-698-8988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty