Organization Active NPI

Ventana Wellness, PC

Doing business as Rogue Clinical Laboratories

  • Clinical Medical Laboratory
  • Medford, OR
National Provider Identifier
1073682506
Registry record updated May 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
VENTANA WELLNESS, PC
Doing business as
Rogue Clinical Laboratories
Practice address
3156 State St
Medford, OR 97504
Phone
(541) 773-9772
Fax
(541) 773-1113
NPI assigned
Nov 7, 2006
Last updated
May 3, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 3, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Kathy Van Es
Title
Billing Supervisor
Phone
(541) 842-7134

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

3156 State St
Medford, OR 97504

Mailing address

3156 State St
Medford, OR 97504-8450
Phone (541) 773-9772

Other names 1

  • Rogue Clinical Laboratories Doing business as

National Provider Directory

National Provider Directory

Locations

3128 State St Ste 101
Medford, OR 97504
Phone (541) 773-9972

3128 State St Ste 101
Medford, OR 97504
Phone (541) 773-9972

749 Golf View Dr
Unit B
Medford, OR 97504
Phone (541) 414-0800

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304380800000",
    "number": "1073682506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3156 STATE ST",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048450",
            "telephone_number": "541-773-9772",
            "fax_number": "541-773-1113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3156 STATE ST",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "97504",
            "telephone_number": "541-773-9772",
            "fax_number": "541-773-1113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VENTANA WELLNESS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2011-05-03",
        "status": "A",
        "authorized_official_last_name": "VAN ES",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "BILLING SUPERVISOR",
        "authorized_official_telephone_number": "541-842-7134",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rogue Clinical Laboratories",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Medford, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.