1578658290 NPI number — ASHLAND MEDICAL SERVICES, INC

Table of content: (NPI 1578658290)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578658290 NPI number — ASHLAND MEDICAL SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASHLAND MEDICAL SERVICES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SO. ORE. MEDICAL EQUIPMENT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578658290
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2305 ASHLAND ST
Provider Second Line Business Mailing Address:
PMB 448
Provider Business Mailing Address City Name:
ASHLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97520-3777
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-773-5994
Provider Business Mailing Address Fax Number:
541-773-6015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 E BARNETT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEDFORD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97504-8283
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-773-5994
Provider Business Practice Location Address Fax Number:
541-773-6015
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CROY
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
WYATT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
541-324-3880

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  07-00028954 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 006035 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 872666000 . This is a "REGENCE BC/BS PPP/PC #" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 200409101 . This is a "REGENCE BC/BS PC 65 #" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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