1780065870 NPI number — UMPQUA VALLEY INTERNISTS PC

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 1780065870 NPI number — UMPQUA VALLEY INTERNISTS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UMPQUA VALLEY INTERNISTS PC
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:
1780065870
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1813 W HARVARD AVE
Provider Second Line Business Mailing Address:
STE 423
Provider Business Mailing Address City Name:
ROSEBURG
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97471-2752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-440-6323
Provider Business Mailing Address Fax Number:
541-440-6399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1813 W HARVARD AVE
Provider Second Line Business Practice Location Address:
STE 423
Provider Business Practice Location Address City Name:
ROSEBURG
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97471-2752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-440-6323
Provider Business Practice Location Address Fax Number:
541-440-6399
Provider Enumeration Date:
06/15/2015

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
541-440-6323

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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