HEALING ROOTS MEDICINE LLC NPI 1477051795

NPI Information

NPI: 1477051795
Provider Name: HEALING ROOTS MEDICINE, LLC
Classification: Clinic/Center - 261QP2300X
Specialization: Primary Care
Entity Type: Organization
:
CLIA Number: 38D2179520
Address: 339 SW CENTURY DR STE 201
BEND, OR
ZIP 97702
Phone: (541) 316-5693

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NPI Details

HEALING ROOTS MEDICINE, LLC is a primary care clinic center in Bend, OR. HEALING ROOTS MEDICINE, LLC NPI is 1477051795. The provider is registered as an organization entity type.
The provider .

The provider's business location address is:

339 SW CENTURY DR STE 201
BEND, OR
ZIP 97702-338
Phone: (541) 316-5693

The provider's authorized official is Havilah Noel Brodhead .
The authorized official title is Co-owner and has the following contact phone number (970) 275-6108.

The CLIA number assigned to this NPI record is 38D2179520 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/1/2018 and was last updated on 2/4/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care	201407546NP-PP	OREGON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	500678393	MEDICAID	OREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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