Organization Name: | MOSAIC MEDICAL |
NPI Number: | 1083633184 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MEGAN MICHELLE HAASE (CEO) |
Mailing Address: | 375 Nw Beaver Street Suite 101 Prineville |
State: | OR US |
Postal Code: | 97754 |
Phone Number: | 5414470707 |
Fax Number: | 5414470708 |
NPI Enumeration Date: | 07/19/2006 |
NPI Last Update Date: | 04/22/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |