Provider Demographics
NPI:1295137495
Name:IMPIPHONY
Entity type:Organization
Organization Name:IMPIPHONY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEJIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD/DO ND
Authorized Official - Phone:541-646-5732
Mailing Address - Street 1:831 TALENT AVE
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540
Mailing Address - Country:US
Mailing Address - Phone:541-646-5732
Mailing Address - Fax:
Practice Address - Street 1:831 TALENT AVE
Practice Address - Street 2:
Practice Address - City:TALENT
Practice Address - State:OR
Practice Address - Zip Code:97540-9613
Practice Address - Country:US
Practice Address - Phone:541-646-5732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHEROCREEK NATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR079264129251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health