FITZGERALD FAMILY MEDICINE (NPI# 1255820239) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255820239 |
| Entity Type | Organization |
| Organization Name | FITZGERALD FAMILY MEDICINE |
| Practice Address |
289 E Ellendale Ave Ste 602 Dallas OR 97338-1570 |
| Mailing Address |
170 W Ellendale Ave Ste 103 Dallas OR 97338-1456 |
| Practice Telephone | 9716121588 |
| Practice Fax Number | 5038313215 |
| Mailing Telephone | 9716121588 |
| Mailing Fax Number | 5038313215 |
| Enumeration Date | 2018-05-06 |
| Last Update Date | 2018-05-06 |
| Authorized Official Name | MRS. ERIN SANFORD FITZGERALD (NURSE PRACTITIONER) |
| Authorized Official Telephone | 9716121588 |
| Authorized Official Credential | FNP-BC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
2015011081 | OR | Ambulatory Health Care Facilities |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | FITZGERALD FAMILY MEDICINE LLC | 16909 Oakdale Rd, Dallas, OR 97338 |
| Street Address |
289 E ELLENDALE AVE STE 602 |
| City | DALLAS |
| State | OR |
| Zip Code | 97338-1570 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164932042 | Stephanie Marie Renfro | Massage Therapist | 289 E Ellendale Ave #601, Dallas, OR 97338 | 2017-10-05 |
| 1588185953 | Herbert Starr Woodward IIi | Dentist | 201 Se Washington St, Dallas, OR 97338 | 2017-07-06 |
| 1851708077 | David Mooso | Pharmacist | 321 Nw Kings Valley Highway, Dallas, OR 97338 | 2014-07-21 |
| 1841615556 | Leslie Lytle | Counselor | 1020 Sw Maple St., Dallas, OR 97338 | 2014-03-04 |
| 1205265493 | Chung-fan Ni | Counselor | 182 S. W. Academy St., Academy Building, Dallas, OR 97338 | 2013-11-07 |
| 1215204300 | Ron Fritz | Counselor | 239 E. Ellendale, Suite 602, Dallas, OR 97338 | 2011-11-17 |
| 1235420167 | Deborah Kennedy | Counselor | 527 Ne Fern Ave, Dallas, OR 97338 | 2011-04-26 |
| 1821229774 | Chelsea Ruhoff Lee | Physician Assistant | 1000 Se Uglow Avenue, Flaming Medical Center, Dallas, OR 97338 | 2009-07-27 |
| 1013128560 | Larry J Vuylsteke | Social Worker | 182 S.w. Academy, Dallas, OR 97338 | 2007-05-25 |
| 1093926123 | Justin W Reed | Counselor | Academy Building, 182 S.w. Academy St. Suite 304, Dallas, OR 97338 | 2007-05-24 |
| Find all providers in zip 97338 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659987022 | Specialists In Geriatric and Palliative Care Medicine Pllc | Clinic/Center | 8198 Walnut Hill Lane, Jackson Bldg, Suite 100, Dallas, TX 75231 | 2020-09-21 |
| 1285275560 | Heavenly Hands Family Medical Clinic, Pllc | Clinic/Center | 7602 Great Trinity Forest Way, Dallas, TX 75217-6650 | 2019-10-08 |
| 1740831098 | Careatc | Clinic/Center | 1500 Marilla St Rm 1cs, Dallas, TX 75201-6318 | 2019-09-26 |
| 1063077824 | Onepeak Medical Clinic, Inc | Clinic/Center | 1910 Greenville Ave, Dallas, TX 75206-7439 | 2019-05-07 |
| 1972068526 | Inkure U LLC | Clinic/Center | 8204 Elmbrook Dr Ste 202, Dallas, TX 75247-4067 | 2019-02-07 |
| 1548752850 | Susan Bacsik Do Pllc | Clinic/Center | 730 N Bishop Ave, Dallas, TX 75208-4338 | 2018-06-01 |
| 1447759212 | Quadmed Medical Clinics of Texas, P.a. D/b/a Quadmed Medical Grou | Clinic/Center | 17655 Waterview Parkway, Dallas, TX 75252 | 2018-02-07 |
| 1700328325 | Daniel Health & Wellness, Pllc | Clinic/Center | 17762 Preston Rd Ste 114, Dallas, TX 75252-5730 | 2016-11-14 |
| 1407205222 | Jayshri Health Services | Clinic/Center | 6315 Lindsley Ave, Dallas, TX 75223-1312 | 2016-06-13 |
| 1437506813 | James Ray Bergmann | Clinic/Center | 2200 Victory Ave, Unit 2404, Dallas, TX 75219-7675 | 2016-05-16 |
| Find all providers in DALLAS | ||||
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| 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.