Provider Demographics
NPI:1518005222
Name:FALL CREEK INTERNAL MEDICINE, LLP
Entity type:Organization
Organization Name:FALL CREEK INTERNAL MEDICINE, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NITA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOLLUMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-389-1118
Mailing Address - Street 1:2160 NE WILLIAMSON CT
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3760
Mailing Address - Country:US
Mailing Address - Phone:541-389-1118
Mailing Address - Fax:541-389-2662
Practice Address - Street 1:2160 NE WILLIAMSON CT
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3760
Practice Address - Country:US
Practice Address - Phone:541-389-1118
Practice Address - Fax:541-389-2662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty