Basic Information
| Provider Information | |||||||||
| NPI: | 1699426684 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ASANTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2650 SISKIYOU BLVD STE 102 | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975048304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417894728 | ||||||||
| FaxNumber: | 5417895393 | ||||||||
| Practice Location | |||||||||
| Address1: | 3011 EAST BARNETT RD | ||||||||
| Address2: | PHARMACY SUITE | ||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417895547 | ||||||||
| FaxNumber: | 5417895678 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2022 | ||||||||
| LastUpdateDate: | 01/12/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BARTLING | ||||||||
| AuthorizedOfficialFirstName: | TONI | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PAYER CONTRACTING PROGRAM MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5417894728 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ASANTE DBA ROGUE REGIONAL MEDICAL CENTER | ||||||||
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| NPICertificationDate: | 01/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | N | Suppliers | Pharmacy | Community/Retail Pharmacy | 3336S0011X | Y | Suppliers | Pharmacy | Specialty Pharmacy |
No ID Information.