1932808318 NPI number — SOUTHERN OREGON CHILDRENS CLINIC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932808318 NPI number — SOUTHERN OREGON CHILDRENS CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN OREGON CHILDRENS CLINIC
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:
Provider Other Organization Name Type Code:
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:
1932808318
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTRAL POINT
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97502-0006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-414-0362
Provider Business Mailing Address Fax Number:
541-200-2269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
891 OHARE PKWY
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:
97504-4005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-200-2243
Provider Business Practice Location Address Fax Number:
541-951-6321
Provider Enumeration Date:
02/24/2023

Additional Information

Authorized Official

Authorized Official Last Name:
REED
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
STEVEN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
541-414-0362

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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