NPIMap

Organization Active NPI

Medford Medical Clinic, LLP

  • Family Medicine Physician
  • Medford, OR
National Provider Identifier
1366449662
Registry record updated May 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD21703 Issued in OR
Legal business name
MEDFORD MEDICAL CLINIC, LLP
Practice address
555 Black Oak Dr
Suite 100
Medford, OR 97504-8447
Phone
(541) 734-3430
Fax
(541) 734-3666
NPI assigned
Jun 30, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2014

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

Authorized official

Name
Mr. Jon Kane Vanvalkenburg, M.D.
Title
Partner
Phone
(541) 734-3430

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X MD21703 OR Primary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X OR
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X OR
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X OR

Addresses

Primary practice location

555 Black Oak Dr
Suite 100
Medford, OR 97504-8447

Mailing address

PO Box 7841
Belfast, ME 04915-7800
Phone (541) 734-3430

National Provider Directory

National Provider Directory

Locations

555 Black Oak Dr
Ste 305
Medford, OR 97504

555 Black Oak Dr
Ste 320
Medford, OR 97504

555 Black Oak Dr
Medford, OR 97504
Phone (541) 734-3434

Practitioners 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399334400000",
    "number": "1366449662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7841",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049157800",
            "telephone_number": "541-734-3430",
            "fax_number": "541-734-3666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 BLACK OAK DR",
            "address_2": "SUITE 100",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048447",
            "telephone_number": "541-734-3430",
            "fax_number": "541-734-3666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDFORD MEDICAL CLINIC, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-30",
        "last_updated": "2014-05-06",
        "status": "A",
        "authorized_official_last_name": "VANVALKENBURG",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "KANE",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "541-734-3430",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD21703",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "OR",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "OR",
            "license": null,
            "primary": false
        }
    ],
    "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 May 6, 2014; 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.