Basic Information
| Provider Information | |||||||||
| NPI: | 1821442930 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LOWER UMPQUA HOSPITAL DISTRICT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 RANCH RD | ||||||||
| Address2: | |||||||||
| City: | REEDSPORT | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974671720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412712171 | ||||||||
| FaxNumber: | 5412719338 | ||||||||
| Practice Location | |||||||||
| Address1: | 385 RANCH RD | ||||||||
| Address2: | |||||||||
| City: | REEDSPORT | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974671707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412712119 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2016 | ||||||||
| LastUpdateDate: | 08/25/2021 | ||||||||
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| AuthorizedOfficialLastName: | GREEN | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CNO | ||||||||
| AuthorizedOfficialTelephone: | 5412712171 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.