Ume Crater Lake LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

UME CRATER LAKE LLC

Practice address

1094 Royal CT
Medford, OR 97504-6138

Phone

(541) 779-4344

NPI assigned

May 19, 2023

Last updated

May 19, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sean Wasden

Title

Coo

Phone

(208) 965-9415

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1684454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684454400000",
    "number": "1326739228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 3RD ST S",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836513840",
            "telephone_number": "208-965-9415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1094 ROYAL CT",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975046138",
            "telephone_number": "541-779-4344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UME CRATER LAKE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-19",
        "last_updated": "2023-05-19",
        "certification_date": "2023-05-19",
        "status": "A",
        "authorized_official_last_name": "WASDEN",
        "authorized_official_first_name": "SEAN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "208-965-9415"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jerry Ugbo, PA-C
• Jordann And Larae Uhrig, QMHA
• Laura Marie Ulloa, MSW, LCSW
• Brennan Ullom, APRN, FNP-C
• Robyn Lynn Ultsch
• Cassandra Lynn Unbankes
• Roylynn Underwood, PMHNP
• University Professional Services (UPS Medford (CDRC - Expansion))
• University Professional Services (University Professional Services in Medford)
• University Professional Services (UPS Medford (CDRC - DMAP))

• Dental Clinic/Center in Medford, OR
• Providers in Medford, OR by specialty
• Dental Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2023; 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.