Organization

Wise Mountain Medicine Llc

Clinic/Center in Bend, OR(View on Map)

Legal Business Name

Wise Mountain Medicine Llc

NPI Number

1316512049

NPI Type

Organization

Enumeration Date

05/25/2021

Specialties

(Taxonomies)

Code

261Q00000X

Primary Taxonomy

Yes

Contact
Information

Purpose

Mailing
Location

Address

2150 NW HILL ST APT 3
335 NE REVERE AVE

City

Bend
Bend

State

OR
OR

Postal Code

97703-1373
97701-4059

Country

US
US

Telephone Number

(970) 406-1019
(541) 238-7285

Authorized Official

Name

Dr. Carlton Kelch

Title or Position

CO-OWNER

Telephone Number

(970) 406-1019

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 05/25/2021

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