Healthcare Provider Details

I. General information

NPI: 1073935078
Provider Name (Legal Business Name): KLAMATH WOMEN'S CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2014
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 MAIN ST SUITE B
KLAMATH FALLS OR
97601-2629
US

IV. Provider business mailing address

1900 MAIN ST SUITE B
KLAMATH FALLS OR
97601-2629
US

V. Phone/Fax

Practice location:
  • Phone: 541-887-8321
  • Fax: 541-887-8322
Mailing address:
  • Phone: 541-887-8321
  • Fax: 541-887-8322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number07-1630
License Number StateOR

VIII. Authorized Official

Name: MS. JEANNE STAGNER
Title or Position: OWNER, PRACTICE MANAGER
Credential: N.P., C.N.M.
Phone: 541-887-8321