Southern Oregon Trauma and Emergency Services, LLC

Primary specialty

Emergency Care Clinic/CenterTaxonomy code 261QE0002X

Legal business name

SOUTHERN OREGON TRAUMA AND EMERGENCY SERVICES, LLC

Practice address

2650 Siskiyou Blvd
Suite 102
Medford, OR 97504-8170

Phone

(541) 789-4728

Fax

(541) 789-4765

NPI assigned

Dec 29, 2006

Last updated

Aug 22, 2020By 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

Marvin D Haas

Title

Chief Admin and Finance Officer

Phone

(541) 789-4103

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1356407662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 SISKIYOU BLVD",
            "address_2": "SUITE 102",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048170",
            "telephone_number": "541-789-4728",
            "fax_number": "541-789-4765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 SISKIYOU BLVD",
            "address_2": "SUITE 102",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048170",
            "telephone_number": "541-789-4728",
            "fax_number": "541-789-4765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN OREGON TRAUMA AND EMERGENCY SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HAAS",
        "authorized_official_first_name": "MARVIN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CHIEF ADMIN AND FINANCE OFFICER",
        "authorized_official_telephone_number": "541-789-4103"
    },
    "taxonomies": [
        {
            "code": "261QE0002X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Emergency Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "226953",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southern Oregon Professional Care Services, Inc. (Visiting Angels)
• Southern Oregon Psychiatry, LLC
• Southern Oregon Sleep Diagnostics (Mountain Sleep Lab)
• Southern Oregon Sleep Diagnostics LLC
• Southern Oregon Spine Care, P.C.
• Southern Oregon Wellness Clinic, LLC (Southern Oregon Medical Clinic)
• Abigail Southgate, LMT
• Heather Dawn Southwick, OTR/L, CAS, CNS-AP
• Sadie Teagan Angelique Souza, LPC
• Arlene Lorraine Sowell, RPH

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.