Basic Information
| Provider Information | |||||||||
| NPI: | 1659519171 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UMPQUA HEALTH - HARVARD, LLC | ||||||||
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| OtherOrganizationName: | UMPQUA REGIONAL MEDICAL CENTER, LLC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1023 | ||||||||
| Address2: | |||||||||
| City: | ROSEBURG | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974700232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414406390 | ||||||||
| FaxNumber: | 5414406392 | ||||||||
| Practice Location | |||||||||
| Address1: | 1813 W HARVARD AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | ROSEBURG | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974712754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414406390 | ||||||||
| FaxNumber: | 5414406392 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2009 | ||||||||
| LastUpdateDate: | 02/08/2017 | ||||||||
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| AuthorizedOfficialLastName: | GOLDBERG | ||||||||
| AuthorizedOfficialFirstName: | SUE | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP, NETWORK & BUSINESS DEVELOPMENT | ||||||||
| AuthorizedOfficialTelephone: | 5414644079 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 261QR1300X | 500609279 | OR | N | Ambulatory Health Care Facilities | Clinic/Center | Rural Health | 261QR1300X | OR | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.