NPIMap

Organization Active NPI

Southern Oregon Medical Practice LLC

  • Family Nurse Practitioner
  • Grants Pass, OR
National Provider Identifier
1184000549
Registry record updated Aug 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1174571186 Issued in OR
Legal business name
SOUTHERN OREGON MEDICAL PRACTICE LLC
Practice address
824 Unit B, Rogue River Highway
Grants Pass, OR 97527-0000
Phone
(541) 244-1261
Fax
(541) 295-8252
NPI assigned
Aug 7, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2015

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

Authorized official

Name
Mr. Stephen Daniel Spalletta
Title
Owner
Phone
(541) 295-4034

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X 1174571186 OR Primary

Addresses

Primary practice location

824 Unit B, Rogue River Highway
Grants Pass, OR 97527-0000

Mailing address

PO Box 2552
Grants Pass, OR 97528-0213
Phone (541) 295-4034

National Provider Directory

National Provider Directory

Locations

824 Rogue River Hwy
#B
Grants Pass, OR 97527
Phone (541) 224-1261

NPI Registry JSON

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

{
    "created_epoch": "1438905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438905600000",
    "number": "1184000549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2552",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975280213",
            "telephone_number": "541-295-4034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "824 UNIT B, ROGUE RIVER HIGHWAY",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975270000",
            "telephone_number": "541-244-1261",
            "fax_number": "541-295-8252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN OREGON MEDICAL PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-07",
        "last_updated": "2015-08-07",
        "status": "A",
        "authorized_official_last_name": "SPALLETTA",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "DANIEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-295-4034",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "1174571186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grants Pass, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2015; 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.