Basic Information
| Provider Information | |||||||||
| NPI: | 1538156179 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEMSTREET | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1475 MT HOOD AVE | ||||||||
| Address2: | |||||||||
| City: | WOODBURN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038731500 | ||||||||
| FaxNumber: | 9705869096 | ||||||||
| Practice Location | |||||||||
| Address1: | 342 FAIRVIEW STREET | ||||||||
| Address2: | |||||||||
| City: | SILVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038731500 | ||||||||
| FaxNumber: | 9705869096 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2005 | ||||||||
| LastUpdateDate: | 07/18/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD150733 | OR | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01360841 | 05 | CO | MEDICAID |