Santiam Memorial Hospital
Organization Active NPI Primary Care Clinic/Center · Stayton, OR
NPI 1467788919 · NPPES record last updated Oct 19, 2009
Key facts
- NPI
- 1467788919
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- Legal business name
- SANTIAM MEMORIAL HOSPITAL
- Practice address
- 1401 N 10TH Ave
Suite 200
Stayton, OR 97383-1311 - Phone
- (503) 769-9362
- Fax
- (503) 769-5416
- NPI assigned
- Oct 19, 2009
- Organization subpart
- No
Authorized official
- Name
- Lynda Fraser
- Title
- Clinic Coordinator
- Phone
- (503) 510-8833
Other NPIs on the same Medicare enrollment 22
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040130000239 | OR | Part B Supplier - Clinic/Group Practice | 6103729751 |
Receives reassigned benefits from 154 practitioners 22 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Mill City, OR; Aumsville, OR; Sublimity, OR; Stayton, OR |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | Yes |
Addresses
Primary practice location
1401 N 10TH Ave
Suite 200
Stayton, OR 97383-1311
Mailing address
1401 N 10TH Ave
Suite 200
Stayton, OR 97383-1311
Phone (503) 769-9362
Other names
- Nancy Dougherty, MD
Other providers in Stayton, OR
- Santiam Memorial Hospital
- Santiam Memorial Hospital
- Santiam Memorial Hospital
- Santiam Memorial Hospital
- Santiam Memorial Hospital
- Santiam Memorial Hospital
- Santiam Memorial Hospital
- Santiam Memorial Hospital
- Santiam Memorial Hospital
- Santiam Memorial Hospital
All providers in Stayton, OR · Primary Care Clinic/Center in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 19, 2009. 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.