SANTIAM MEMORIAL HOSPITAL (NPI# 1205048097) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205048097 |
| Entity Type | Organization |
| Organization Name | SANTIAM MEMORIAL HOSPITAL |
| Other Organization Name | SANTIAM MEDICAL CLINIC |
| Practice Address |
280 S First Ave Mill City OR 97360 |
| Mailing Address |
Po Box 47 Mill City OR 97360-0047 |
| Practice Telephone | 5038974100 |
| Practice Fax Number | 5038972673 |
| Mailing Telephone | 5038974100 |
| Mailing Fax Number | 5038972673 |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2016-09-28 |
| Authorized Official Name | SHANNON R WADDLE (OFFICE MANAGER) |
| Authorized Official Telephone | 5038974100 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Santiam Medical Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154302214 | Santiam Memorial Hospital | General Acute Care Hospital | 1401 N 10th Ave, Stayton, OR 97383-1485 | 2005-11-07 |
| 1023628419 | Santiam Memorial Hospital | Clinic/Center | 5000 Deer Park Dr Se, Salem, OR 97317-9392 | 2020-07-31 |
| 1154814390 | Santiam Memorial Hospital | Clinic/Center | 1371 N 10th Ave, Stayton, OR 97383 | 2018-06-12 |
| 1912413147 | Santiam Memorial Hospital | Clinic/Center | 1369 N 10th Ave, Stayton, OR 97383 | 2017-12-26 |
| 1275049850 | Santiam Memorial Hospital | Clinic/Center | 1401 N 10th Ave Ste 200, Stayton, OR 97383 | 2017-12-19 |
| 1982154712 | Santiam Memorial Hospital | General Acute Care Hospital | 1401 N 10th Ave, Stayton, OR 97383-1311 | 2016-10-05 |
| 1477909570 | Santiam Memorial Hospital | Clinic/Center | 1401 N 10th Ave, Ste. 100, Stayton, OR 97383-1486 | 2016-05-06 |
| 1518354547 | Santiam Memorial Hospital | Clinic/Center | 114 Se Church St, Sublimity, OR 97385-9714 | 2015-04-16 |
| 1790171874 | Santiam Memorial Hospital | Clinic/Center | 1375 N 10th Ave, Suite B, Stayton, OR 97383-2099 | 2015-04-15 |
| 1396131389 | Santiam Memorial Hospital | Clinic/Center | 280 S 1st Ave, Mill City, OR 97360-0003 | 2015-04-07 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | SANTIAM MEMORIAL HOSPITAL | 1401 N 10th Ave, Stayton, OR 97383 |
| System for Award Management (SAM) Entities | SANTIAM MEMORIAL HOSPITAL | 1401 N 10th Ave, Stayton, OR 97383-1311 |
| Street Address |
280 S FIRST AVE |
| City | MILL CITY |
| State | OR |
| Zip Code | 97360 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134180714 | Cynthia Marion Peticolas | Dentist | 548 S 1st Ave, Mill City, OR 97360 | 2006-03-31 |
| 1518999184 | Thomas A. Vanveen | Family Medicine | 280 S 1st Ave, Mill City, OR 97360-0003 | 2006-07-06 |
| 1396131389 | Santiam Memorial Hospital | Clinic/Center | 280 S 1st Ave, Mill City, OR 97360-0003 | 2015-04-07 |
| 1588869119 | Amy Sutkus | Family Medicine | 280 S 1st Ave, Mill City, OR 97360-0003 | 2007-06-15 |
| 1639269780 | Santiam Canyon School District 129j | Local Education Agency (LEA) | 150 Sw Evergreen Street, Mill City, OR 97360-0197 | 2006-10-12 |
| 1134451784 | Joseph Peter Lulich | Nurse Practitioner | 280 S 1st Ave, Mill City, OR 97360-2324 | 2010-02-08 |
| 1275708000 | Lynn Eleanor-johnson Gower | Family Medicine | 280 S 1st Ave, Mill City, OR 97360-2324 | 2008-04-23 |
| 1053456392 | Krasar Inc | Pharmacy | 218 Sw Broadway St, Mill City, OR 97360-2411 | 2007-02-21 |
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518999184 | Thomas A. Vanveen | Family Medicine | 280 S 1st Ave, Mill City, OR 97360-0003 | 2006-07-06 |
| 1275708000 | Lynn Eleanor-johnson Gower | Family Medicine | 280 S 1st Ave, Mill City, OR 97360-2324 | 2008-04-23 |
| 1588869119 | Amy Sutkus | Family Medicine | 280 S 1st Ave, Mill City, OR 97360-0003 | 2007-06-15 |
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|---|---|---|---|---|
| 1992306344 | Emily Herrmann | Family Medicine | 1965 Alder St, Eugene, OR 97405-2937 | 2020-11-03 |
| 1366041071 | Christina Cabelly | Family Medicine | 16305 Sw Loon Dr, Beaverton, OR 97007-8989 | 2020-10-23 |
| 1386242790 | Rose City Medical Clinic LLC | Family Medicine | 11397 Se Cascade View Ct, Clackamas, OR 97086-9753 | 2020-10-16 |
| 1346847332 | Jasmine Barnhart | Family Medicine | 1935 Canyon Ave, Medford, OR 97504-2128 | 2020-10-03 |
| 1255949434 | Deep Creek Family Medicine | Family Medicine | 39084 Proctor Blvd Ste A, Sandy, OR 97055-8064 | 2020-07-14 |
| 1316569635 | Doctors On Video | Family Medicine | 13215 Sw Hawks Beard St Apt 726, Tigard, OR 97223-2125 | 2020-05-08 |
| 1710510094 | Gresham Family Care Inc | Family Medicine | 1800 Blankenship Rd Ste 350, West Linn, OR 97068-4182 | 2020-02-14 |
| 1962041707 | Shift Bend Functional Medicine | Family Medicine | 151 Sw Shevlin Hicks Dr, Suite #1, Bend, OR 97702 | 2019-12-26 |
| 1083252472 | Driven Enterprises PC | Family Medicine | 20700 Wandalea Dr, Bend, OR 97701-1594 | 2019-12-16 |
| 1891331195 | Praxis Medical Group Inc | Family Medicine | 1426 Oak Street, Eugene, OR 97401-4043 | 2019-11-21 |
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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.