1598895690 NPI number — ASANTE THREE RIVERS MEDICAL CENTER LLC

Table of content: (NPI 1598895690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598895690 NPI number — ASANTE THREE RIVERS MEDICAL CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASANTE THREE RIVERS MEDICAL CENTER LLC
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:
TRMC PROFESSIONAL SERVICES
Provider Other Organization Name Type Code:
5
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:
1598895690
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4749
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDFORD
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97501-0227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-789-5516
Provider Business Mailing Address Fax Number:
541-789-5518

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 SW RAMSEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANTS PASS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-472-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROWENHORST
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCE OFFICER
Authorized Official Telephone Number:
541-789-4549

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 141439 , 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: 028289 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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