Basic Information
| Provider Information | |||||||||
| NPI: | 1346218252 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KLAMATH WALK IN CARE CENTER INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2655 SHASTA WAY | ||||||||
| Address2: | SUITE #7 | ||||||||
| City: | KLAMATH FALLS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 976034455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418822118 | ||||||||
| FaxNumber: | 5418820617 | ||||||||
| Practice Location | |||||||||
| Address1: | 2655 SHASTA WAY | ||||||||
| Address2: | SUITE #7 | ||||||||
| City: | KLAMATH FALLS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 976034455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418822118 | ||||||||
| FaxNumber: | 5418820617 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 06/04/2013 | ||||||||
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| AuthorizedOfficialLastName: | PUFFENBARGER | ||||||||
| AuthorizedOfficialFirstName: | KATHLEEN | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5418822118 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | FNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
ID Information
| ID | Type | State | Issuer | Description | 277731 | 05 | OR | MEDICAID |