NPIMap

Organization Active NPI

Southern Oregon Nutrition & Diabetes Training Center

  • Registered Dietitian
  • Medford, OR
National Provider Identifier
1104907609
Registry record updated Jul 23, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
366 Issued in OR
Legal business name
SOUTHERN OREGON NUTRITION & DIABETES TRAINING CENTER
Practice address
825 E Main St
Suite C
Medford, OR 97504-7133
Phone
(541) 245-0713
Fax
(541) 779-3526
NPI assigned
Oct 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2007

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

Authorized official

Name
Susan L Spiva, RD, CDE
Title
Dietitian/Owner
Phone
(541) 245-0713

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193400000X SINGLE SPECIALTY GROUP 133V00000X 366 OR Primary

Addresses

Primary practice location

825 E Main St
Suite C
Medford, OR 97504-7133

Mailing address

825 E Main St
Suite C
Medford, OR 97504-7133
Phone (541) 245-0713

National Provider Directory

National Provider Directory

Locations

825 E Main St
Ste C
Medford, OR 97504
Phone (541) 245-0713

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185148800000",
    "number": "1104907609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 E MAIN ST",
            "address_2": "SUITE C",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975047133",
            "telephone_number": "541-245-0713",
            "fax_number": "541-779-3526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 E MAIN ST",
            "address_2": "SUITE C",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975047133",
            "telephone_number": "541-245-0713",
            "fax_number": "541-779-3526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN OREGON NUTRITION & DIABETES TRAINING CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2007-07-23",
        "status": "A",
        "authorized_official_last_name": "SPIVA",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DIETITIAN/OWNER",
        "authorized_official_telephone_number": "541-245-0713",
        "authorized_official_credential": "RD, CDE"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "OR",
            "license": "366",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Jul 23, 2007; 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.