MEDICARE: SANTIAM MEMORIAL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1205048097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTIAM MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	PO BOX 47
Second Line	:
City	:	MILL CITY
State	:	OR
Zip	:	97360-0047
Country	:	US
Telephone Number	:	503-897-4100
Fax Number	:	503-897-2673

Provider Business Practice Location Address
First Line	:	280 S FIRST AVE
Second Line	:
City	:	MILL CITY
State	:	OR
Zip	:	97360
Country	:	US
Telephone Number	:	503-897-4100
Fax Number	:	503-897-2673

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SHANNON R WADDLE
Credential	:
Telephone Number	:	503-897-4100

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	09/28/2016

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