Alder Medical Center PC
Organization Active NPI Family Medicine Physician · Brookings, OR
NPI 1063400968 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1063400968
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD22599 (OR)
- Legal business name
- ALDER MEDICAL CENTER PC
- Practice address
- 412 Alder St
Brookings, OR 97415-9014 - Phone
- (541) 469-5919
- Fax
- (541) 469-6710
- NPI assigned
- Oct 13, 2005
- Organization subpart
- No
Authorized official
- Name
- Kelly Hough Lowther, MD
- Title
- President
- Phone
- (541) 469-5919
Practitioners 3
-
Robert W. Petzold, M.D.
-
Sande R Jacobson, DC
-
Kelly H Lowther, MD
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | MD22599 | OR | Yes |
Addresses
Primary practice location
412 Alder St
Brookings, OR 97415-9014
Mailing address
PO Box 5750
Brookings, OR 97415-0125
Phone (541) 469-5919
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 288201 | Medicaid | OR |
Other names
- Alder Medical Center
Other providers in Brookings, OR
- Active Life Physical Therapy Center Inc
- Kathleen Lynnette Adamson
- Adapt
- Adapt
- Adaptive Health Consultants, LLC
- Kalinna Alderman
- Jessica Allen
- Bridget Paige Allison
- Linda Marie Almeida
- Troy Alvarado
All providers in Brookings, OR · Family Medicine Physician in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.