SOUTHERN OREGON INTERNAL MEDICINE (NPI# 1730202433) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730202433 |
| Entity Type | Organization |
| Organization Name | SOUTHERN OREGON INTERNAL MEDICINE |
| Practice Address |
2900 Doctors Park Dr Medford OR 97504-8127 |
| Practice Telephone | 5412822208 |
| Practice Fax Number | 5412822237 |
| Mailing Telephone | 5412822208 |
| Mailing Fax Number | 5412822237 |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | VICKI S WAGNER (CEO) |
| Authorized Official Telephone | 5412822217 |
| Authorized Official Credential | CEO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | SOUTHERN OREGON INTERNAL MEDICINE | 2900 Doctors Park Dr Ste 200, Medford, OR 97504 |
| Street Address |
2900 DOCTORS PARK DR |
| City | MEDFORD |
| State | OR |
| Zip Code | 97504-8127 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699761932 | Rogue Valley Physicians | Nurse Practitioner | 2900 Doctors Park Dr, Medford, OR 97504-8127 | 2005-09-22 |
| 1275767055 | Eric Martin, Md P.c | Clinic/Center | 2900 Doctors Park Dr, Suite 100, Medford, OR 97504-8198 | 2009-05-08 |
| 1164656948 | Timothy R. Driver, Md P.C. | Clinic/Center | 2900 Doctors Park Dr, Suite 100, Medford, OR 97504-8198 | 2009-05-08 |
| 1952535734 | James Loos, Md P.C. | Clinic/Center | 2900 Doctors Park Dr, Suite 100, Medford, OR 97504-8198 | 2009-05-08 |
| 1104082577 | Cancer Care of Southern Oregon | Radiology | 2900 Doctors Park Dr, Medford, OR 97504-8198 | 2008-08-05 |
| 1710169099 | Patrick Ryan Hungerford | Internal Medicine | 2900 Doctors Park Dr, Suite 200, Medford, OR 97504-8198 | 2007-11-29 |
| 1285851071 | Rogue Valley Physicians | Clinic/Center | 2900 Doctors Park Dr, Medford, OR 97504-8127 | 2007-04-20 |
| 1760587372 | Eric Martin | Urology | 2900 Doctors Park Dr, Suite 100, Medford, OR 97504-8198 | 2006-09-14 |
| 1669577268 | Timothy Robert Driver | Specialist | 2900 Doctors Park Dr, Suite 100, Medford, OR 97504-8198 | 2006-09-14 |
| 1104922749 | Urology Associates of Southern Oregon, LLP | Clinic/Center | 2900 Doctors Park Dr, Suite 100, Medford, OR 97504-8198 | 2006-09-14 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225673833 | Lydia D Sneed | Behavioral Analyst | 3707 Citation Way, Suite 102, Medford, OR 97504 | 2019-11-07 |
| 1114577368 | Heather Ashley Fronek | Nurse Practitioner | 2825 E. Barnett Rd., Medford, OR 97504 | 2019-09-18 |
| 1255809109 | Justin Blasdel | Technician, Health Information | 3250 Lone Pine Rd, Medford, OR 97504 | 2018-11-08 |
| 1396220133 | Aimee K Michel | Massage Therapist | 3550 National Dr., Medford, OR 97504 | 2018-09-27 |
| 1437646908 | Zola Dental Medford LLC | Dentist | 922 E Main, Medford, OR 97504 | 2018-04-19 |
| 1376068015 | Megan Leggett | Counselor | 777 Murphy Road, Medford, OR 97504 | 2017-08-03 |
| 1023547536 | Joshua Morgan Rice | Dentist | 1117 E Main St Ste 1, Medford, OR 97504 | 2017-06-08 |
| 1427580232 | Paul James Dean | Counselor | 1175 Main St Ste 1c, Medford, OR 97504 | 2017-03-30 |
| 1811443542 | Taya Adams | Doula | 1201 Progress Dr #90, Medford, OR 97504 | 2016-09-01 |
| 1174076228 | Avalon Health Care - Hearthstone, LLC | Skilled Nursing Facility | 2091 E. Barnett Road, Medford, OR 97504 | 2016-07-25 |
| Find all providers in zip 97504 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275157000 | Provident Health Partners Inc. | Clinic/Center | 1529 N Ocean Ave Ste A, Medford, NY 11763-3587 | 2020-06-08 |
| 1427680057 | Ortc, LLC | Clinic/Center | 750 Biddle Rd Ste 102, Medford, OR 97504-6178 | 2020-02-11 |
| 1528543949 | Planned Parenthood of Southwestern Oregon | Clinic/Center | 125 S Central Ave Ste 201, Medford, OR 97501-7222 | 2018-10-02 |
| 1417438359 | Ideal Option, Pllc | Clinic/Center | 216 E Main St Ste 201, Medford, OR 97501-6029 | 2018-08-28 |
| 1750828778 | Regis College | Clinic/Center | 50 Dexter St, 1, Medford, MA 02155-6668 | 2017-01-28 |
| 1629428248 | Southern Oregon Denture & Dental | Clinic/Center | 41 Hawthorne St, Medford, OR 97504-7113 | 2016-06-14 |
| 1881021715 | Oregon Health Sciences University | Clinic/Center | 3192 Arnold Palmer Way, Medford, OR 97504-7773 | 2013-10-10 |
| 1023372067 | Riverside Chiropractic Wellness Centers, Inc | Clinic/Center | 65 Riverside Ave Ste C, Medford, MA 02155-4653 | 2012-06-25 |
| 1497051320 | Northwest Diagnostic Services | Clinic/Center | 2728 W Main St, Suite 121, Medford, OR 97501-2499 | 2011-02-10 |
| 1265745541 | Oregon Internal Medicine, LLC. | Clinic/Center | 2380 W Main St, Suite, A, Medford, OR 97501-2390 | 2010-07-15 |
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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.