Allergy & Asthma Center of Southern Oregon PC
Organization Active NPI Allergy Physician · Klamath Falls, OR
NPI 1164562401 · NPPES record last updated Jul 13, 2020
Key facts
- NPI
- 1164562401
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Allergy Physician 207KA0200X
- Legal business name
- ALLERGY & ASTHMA CENTER OF SOUTHERN OREGON PC
- Practice address
- 2628 Clover St
Klamath Falls, OR 97601-1132 - Phone
- (541) 858-1003
- Fax
- (541) 857-4499
- NPI assigned
- Feb 7, 2007
- Organization subpart
- No
Authorized official
- Name
- Edward Kerwin, MD
- Title
- Physician Owner
- Phone
- (541) 858-1003
Other NPIs on the same Medicare enrollment 4
Practitioners 8
-
Kary Anne Kelly, NP-PP
-
Kevin Wilson Parks, M.D.
-
Joann Lanae Reed, MSN, NP-C
-
Sarah L Crawford, NP
-
Ryan B Israelsen, M.D.
-
Edward Kerwin, M.D.
-
Jaleh Ostovar, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070601000084 | OR | Part B Supplier - Clinic/Group Practice | 1355449141 |
Receives reassigned benefits from 8 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Ashland, OR; Grants Pass, OR; Klamath Falls, OR; Medford, OR; Roseburg, OR |
National Provider Directory
Locations
3860 Crater Lake Ave
Medford, OR 97504
Phone (541) 858-1003
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Allergy Physician |
207KA0200X | Yes |
Addresses
Primary practice location
2628 Clover St
Klamath Falls, OR 97601-1132
Mailing address
3860 Crater Lake Ave
Medford, OR 97504-9741
Phone (541) 858-1003
Other providers in Klamath Falls, OR
- Alison Sanders LMT
- Abdallah Alkhaldi
- Eric Allen
- Scott Michael Allen
- Heather Allensworth
- Joesph Allred
- Lisa Kay Allred
- Samara Allred
- Maria G Alonso
- Cynthia Alonzo-Leon
All providers in Klamath Falls, OR · Allergy 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 Jul 13, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.