Healthcare Provider Details

I. General information

NPI: 1922814078
Provider Name (Legal Business Name): SOUTHERN OREGON MIDWIFERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 4TH ST
ASHLAND OR
97520-2044
US

IV. Provider business mailing address

584 JAMES ST
TALENT OR
97540-9764
US

V. Phone/Fax

Practice location:
  • Phone: 541-833-0024
  • Fax: 888-453-0682
Mailing address:
  • Phone: 541-621-6315
  • Fax: 888-453-0682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name: JESSICA S RUEDIGER
Title or Position: CO-OWNER, MIDWIFE
Credential: LDM, CPM
Phone: 541-621-6315