Healthcare Provider Details

I. General information

NPI: 1558358721
Provider Name (Legal Business Name): HEART CLINIC OF SOUTHERN OREGON & NORTHERN CALIFORNIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 MEDICAL CENTER DR SUITE 200
MEDFORD OR
97504-4314
US

IV. Provider business mailing address

520 MEDICAL CENTER DR STE 200
MEDFORD OR
97504-4334
US

V. Phone/Fax

Practice location:
  • Phone: 541-282-6600
  • Fax: 541-282-6608
Mailing address:
  • Phone: 541-282-6600
  • Fax: 541-282-6608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. REGAN W DAILEY
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 541-282-6620