Basic Information
| Provider Information | |||||||||
| NPI: | 1760418032 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GRANTS PASS CLINIC LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 495 SW RAMSEY AVE | ||||||||
| Address2: | |||||||||
| City: | GRANTS PASS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975275681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414725580 | ||||||||
| FaxNumber: | 5414725673 | ||||||||
| Practice Location | |||||||||
| Address1: | 495 RAMSEY AVE | ||||||||
| Address2: | |||||||||
| City: | GRANTS PASS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975275681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414766644 | ||||||||
| FaxNumber: | 5414725673 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2006 | ||||||||
| LastUpdateDate: | 10/18/2011 | ||||||||
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| AuthorizedOfficialLastName: | GASSAWAY | ||||||||
| AuthorizedOfficialFirstName: | ROSS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5414725500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207RI0200X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 208000000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 208600000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | 213E00000X | N | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | 332B00000X | OR | N | Suppliers | Durable Medical Equipment & Medical Supplies | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.