OPTIMAL HEALTH OF SOUTHERN OREGON, LLC (NPI# 1902353907) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902353907 |
| Entity Type | Organization |
| Organization Name | OPTIMAL HEALTH OF SOUTHERN OREGON, LLC |
| Practice Address |
1600 Nw 6th St South Suite Grants Pass OR 97526 |
| Practice Telephone | 5415071948 |
| Practice Fax Number | 5417270382 |
| Mailing Telephone | 5415071948 |
| Mailing Fax Number | 5417270382 |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2018-04-18 |
| Authorized Official Name | WENDELL CHARLES HEIDINGER (OWNER) |
| Authorized Official Telephone | 5415071948 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | MD18680 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 190932 | 05 |
| Street Address |
1600 NW 6TH ST SOUTH SUITE |
| City | GRANTS PASS |
| State | OR |
| Zip Code | 97526 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205476777 | Kyla M Mccormick | Peer Specialist | 109 Nw Manzanita Avenue, Grants Pass, OR 97526 | 2020-01-13 |
| 1164076469 | Alicia Yvonne Hansen | Counselor | 1055 Clarey St., Grants Pass, OR 97526 | 2019-07-25 |
| 1841842598 | Michael Liam Reynolds, Dds, LLC | Dentist | 984 Ne 8th Street, Grants Pass Oregon, Grants Pass, OR 97526 | 2019-07-12 |
| 1881254746 | Brandi Mccrorey | Counselor | 418 Ne 6th Street, Suite 102, Grants Pass, OR 97526 | 2019-06-13 |
| 1700364502 | Premier Community Supports, LLC. | Day Training, Developmentally Disabled Services | 1439 Ne 6th St Ste C, Grants Pass, OR 97526 | 2018-08-02 |
| 1821584509 | Stefani Mcintyre | Massage Therapist | 1590 Se N Street, Warehouse #1574, Grants Pass, OR 97526 | 2018-07-06 |
| 1114467438 | Sandra P Martin | Chiropractor | 333 Sw 5th St. Suite B, Grants Pass, OR 97526 | 2017-03-06 |
| 1801347612 | Maci Wageman | Counselor | 1215 Sw G St Grants Pass Oregon 97526, Grants Pass, OR 97526 | 2016-10-17 |
| 1982150793 | Tanya White | Counselor | 402 Nw Fstreet, Grants Pass, OR 97526 | 2016-08-31 |
| 1871968602 | Jeffrey A Christophersen | Counselor | 109 Nw Manzanita Ave, Grants Pass, OR 97526 | 2015-12-04 |
| Find all providers in zip 97526 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821308032 | Angela C Mount | Family Medicine | 520 Sw Ramsey Suite 101, Grants Pass, OR 97527-5535 | 2010-10-21 |
| 1003049818 | Volodymyr Y. Dovhyy | Family Medicine | 520 Sw Ramsey, Suite 101, Grants Pass, OR 97527-5535 | 2009-08-26 |
| 1861443186 | Heather A. Kahn, Md PC | Family Medicine | 702 Sw Ramsey Ave, Suite 120, Grants Pass, OR 97527 | 2006-05-12 |
| 1902854896 | Thomas Martin Turek | Family Medicine | 124 Midland Ave., Grants Pass, OR 97526 | 2006-05-04 |
| 1821077157 | Beverly Ann Steinman | Family Medicine | 125 Ne Manzanita Ave, Grants Pass, OR 97526-1400 | 2006-01-13 |
| 1366438095 | Jon Ermshar | Family Medicine | 1716 Williams Hwy, Grants Pass, OR 97527-5661 | 2005-09-27 |
| 1003809666 | Steven R Foutz | Family Medicine | 124b Nw Midland Ave, Grants Pass, OR 97526-1267 | 2005-08-29 |
| 1740272285 | Kristin Miller | Family Medicine | 1701 Nw Hawthorne Ave, Suite 201, Grants Pass, OR 97526-1257 | 2005-08-19 |
| 1508858051 | Dan P Gleffe | Family Medicine | 1587 Nw Washington Blvd, Grants Pass, OR 97526-1085 | 2005-08-19 |
| 1194725069 | Barry Hamann | Family Medicine | 741 Ne 7th St, Grants Pass, OR 97526-1632 | 2005-07-21 |
| Find all providers in GRANTS PASS | ||||
| City | GRANTS PASS |
| Zip Code | 97526 |
Please comment or provide details below to improve the information on OPTIMAL HEALTH OF SOUTHERN OREGON, 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.