1134158983 NPI number — CARDIOVASCULAR INSTITUTE OF SOUTHERN OREGON, LLC

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 1134158983 NPI number — CARDIOVASCULAR INSTITUTE OF SOUTHERN OREGON, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIOVASCULAR INSTITUTE OF SOUTHERN OREGON, 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:
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:
1134158983
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 MEDICAL CENTER DR
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
MEDFORD
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97504-4334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-282-6660
Provider Business Mailing Address Fax Number:
541-282-6661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
MEDFORD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97504-4334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-282-6660
Provider Business Practice Location Address Fax Number:
541-282-6661
Provider Enumeration Date:
07/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHNUGG
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT - BOARD OF DIRECTORS
Authorized Official Telephone Number:
541-282-6660

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 247301 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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