Provider Demographics
NPI:1831229491
Name:OREGON CLINIC, INC.
Entity type:Organization
Organization Name:OREGON CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-691-8132
Mailing Address - Street 1:3841 NAVARRE AVE
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3435
Mailing Address - Country:US
Mailing Address - Phone:419-691-8132
Mailing Address - Fax:419-691-5170
Practice Address - Street 1:3841 NAVARRE AVE
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3435
Practice Address - Country:US
Practice Address - Phone:419-691-8132
Practice Address - Fax:419-691-5170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0515213Medicaid
OHOR-9161422Medicare ID - Type Unspecified
OH0515213Medicaid