MEDICARE: GERIATRIC CONSULTATION SERVICE OF SOUTHERN OREGON

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	207QG0300X	Geriatric Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1861442980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERIATRIC CONSULTATION SERVICE OF SOUTHERN OREGON

Provider Business Mailing Address
First Line	:	1208 BEALL LN
Second Line	:
City	:	CENTRAL POINT
State	:	OR
Zip	:	97502-1573
Country	:	US
Telephone Number	:	541-664-5151
Fax Number	:	541-664-5155

Provider Business Practice Location Address
First Line	:	2960 DOCTORS PARK DR
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97504-8127
Country	:	US
Telephone Number	:	541-608-7562
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEPHEN BRUMMER
Credential	:
Telephone Number	:	541-608-7562

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	11/26/2007

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