FULL BLOOM NATURAL MEDICINE, LLC (NPI# 1871153585) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871153585 |
| Entity Type | Organization |
| Organization Name | FULL BLOOM NATURAL MEDICINE, LLC |
| Other Organization Name | FULL BLOOM NATURAL MEDICINE |
| Practice Address |
922 Nw Circle Blvd Ste 180 Corvallis OR 97330-1483 |
| Practice Telephone | 5412246738 |
| Mailing Telephone | 5412246738 |
| Enumeration Date | 2019-06-14 |
| Last Update Date | 2019-12-09 |
| Authorized Official Name | MARY BOUCHER (DR.) |
| Authorized Official Telephone | 5412246738 |
| Authorized Official Credential | ND |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Full Bloom Natural Medicine | Doing Business As Name - Organization |
| Mary J Boucher, ND | Former Legal Business Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | FULL BLOOM NATURAL MEDICINE, LLC | 922 Nw Circle Blvd Ste 180, Corvallis, OR 97330 |
| Street Address |
922 NW CIRCLE BLVD STE 180 |
| City | CORVALLIS |
| State | OR |
| Zip Code | 97330-1483 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760020200 | Mary J Boucher | Naturopath | 922 Nw Circle Blvd Ste 180, Corvallis, OR 97330-1483 | 2019-12-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235754912 | Miya Claborn | Counselor | 4495 Se Hwy 20, Corvallis, OR 97330 | 2020-06-09 |
| 1548889017 | Greydi Olvera | Counselor | Childrens Farm Home 4455 Ne Hwy 20, Corvallius, OR 97330 | 2020-04-14 |
| 1053953992 | Andie Marie Gaipo | Counselor | 4455 Ne Hwy 20 - Children's Farm Home, Corvallis, OR 97330 | 2019-10-11 |
| 1740847177 | Stephen Jack Eccles | Behavior Technician | Trillium Children's Farm Home, 4455 Ne Hwy 20, Corvallis, OR 97330 | 2019-05-21 |
| 1750944815 | Tiffany Rene Flinchpaugh | Counselor | Children's Farm Home 4455 Hwy 20, Corvallis, OR 97330 | 2019-04-15 |
| 1679035455 | Isaiah Mile Cassidy | Counselor | Children's Farm Home-4455 Ne Hwy 20, Corvallis, OR 97330 | 2019-04-02 |
| 1982168399 | Haylee Cramblit | Counselor | Children's Farm Home 4455 Ne Hwy 20, Corvallis, OR 97330 | 2019-01-30 |
| 1457835365 | Ashley Alyn Couch | Counselor | 4455 Hwy 20 Corvallis 97330, Corvallis, OR 97330 | 2018-09-18 |
| 1104318898 | Megan Gerding | Technician, Other | 996 Nw Circle Blvd Suite 103, Corvallis, OR 97330 | 2018-05-30 |
| 1700377108 | Pacific Hearing Services | Audiologist | 975 Nw Spruce Ave, Suite #101, Corvallis, OR 97330 | 2018-05-22 |
| Find all providers in zip 97330 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235476680 | Michael Sorah | Clinic/Center | 999 Nw Circle Blvd, Corvallis, OR 97330-1408 | 2013-01-04 |
| 1700148251 | Samaritan Chiropractic LLC | Clinic/Center | 634 Nw 4th St, Corvallis, OR 97330-6413 | 2012-06-11 |
| 1154616266 | Frances S. Spiller, D.o., P.C. | Clinic/Center | 2298 Nw Kings Blvd, Corvallis, OR 97330-3923 | 2011-06-16 |
| 1467746065 | House Call Doc LLC | Clinic/Center | 2610 Nw Glenwood Dr, House Call Doc, LLC, Corvallis, OR 97330-3134 | 2011-06-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376158774 | G&h Healthcare Inc | Clinic/Center | 17022 Sw Pacific Hwy Apt 210, Tigard, OR 97224-3400 | 2020-09-11 |
| 1750906509 | Alpha Care Family Medicine | Clinic/Center | 14455 Sw Allen Blvd Ste 100, Beaverton, OR 97005-4428 | 2020-06-08 |
| 1104447895 | Beyond Health LLC | Clinic/Center | 6440 Nw Mcmullen Ave, Portland, OR 97229-1158 | 2020-05-04 |
| 1851942536 | Careatc | Clinic/Center | 1101 W Main St Ste 103, Medford, OR 97501-2966 | 2019-09-24 |
| 1831757475 | Structural Solutions Chiropractic | Clinic/Center | 121 Nw Everett St, Portland, OR 97209-4049 | 2019-05-29 |
| 1770147357 | Uptown Providers PC | Clinic/Center | 397 Warner Milne Rd, Oregon City, OR 97045-4045 | 2019-04-29 |
| 1720549058 | Barbara Gilbertson, Do, Inc. | Clinic/Center | 1803b Main St, Klamath Falls, OR 97601-2636 | 2019-03-28 |
| 1033674841 | Jeremy Mikolai Nd Inc | Clinic/Center | 2540 Ne M L King Blvd, Portland, OR 97212-3732 | 2019-02-06 |
| 1326531666 | Working Class Medicine LLC | Clinic/Center | 2133 N. Willis Blvd, Studio D, Portland, OR 97217 | 2018-06-12 |
| 1255820239 | Fitzgerald Family Medicine | Clinic/Center | 289 E Ellendale Ave Ste 602, Dallas, OR 97338-1570 | 2018-05-06 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on FULL BLOOM NATURAL MEDICINE, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.