SOUTHERN OREGON TRAUMA AND EMERGENCY SERVICES LLC NPI 1356407662

NPI Information

NPI: 1356407662
Provider Name: SOUTHERN OREGON TRAUMA AND EMERGENCY SERVICES, LLC
Classification: Clinic/Center - 261QE0002X
Entity Type: Organization

Specialization: Emergency Care

Address:
2650 SISKIYOU BLVD
SUITE 102
MEDFORD, OR
ZIP 97504
Phone: (541) 789-4728
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SOUTHERN OREGON TRAUMA AND EMERGENCY SERVICES, LLC is an emergency care clinic center in Medford, OR. SOUTHERN OREGON TRAUMA AND EMERGENCY SERVICES, LLC NPI is 1356407662. The provider is registered as an organization entity type.

The provider's business location address is:

2650 SISKIYOU BLVD
SUITE 102
MEDFORD, OR
ZIP 97504-170
Phone: (541) 789-4728
Fax: (541) 789-4765

The provider's authorized official is Marvin D Haas .
The authorized official title is Chief Admin And Finance Officer and has the following contact phone number (541) 789-4103.

The enumeration date for this NPI number is 12/29/2006 and was last updated on 8/22/2020.

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	261QE0002X	Clinic/Center	Emergency Care			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	226953	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: 5/5/2024

NPI Synchronization or Removal

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