MEDICARE: SOUTHERN OREGON FRIENDS OF HOSPICE

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	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952990566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN OREGON FRIENDS OF HOSPICE

Provider Business Mailing Address
First Line	:	217 S MODOC AVE
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97504-7782
Country	:	US
Telephone Number	:	541-941-5960
Fax Number	:

Provider Business Practice Location Address
First Line	:	217 S MODOC AVE
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97504-7782
Country	:	US
Telephone Number	:	541-941-5960
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	PAMELA NORR
Credential	:
Telephone Number	:	541-500-8911

Provider Enumeration Date	:	01/18/2021
Last Update Date	:	01/18/2021

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Directions to “SOUTHERN OREGON FRIENDS OF HOSPICE ” Practice Location

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