Healthcare Provider Details

I. General information

NPI: 1104064617
Provider Name (Legal Business Name): SMJ CONSULTING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 01/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 E MCANDREWS RD STE 101
MEDFORD OR
97504-6177
US

IV. Provider business mailing address

1322 E MCANDREWS RD STE 101
MEDFORD OR
97504-6177
US

V. Phone/Fax

Practice location:
  • Phone: 541-770-1650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REGINA PURTZER
Title or Position: SECRETARY
Credential:
Phone: 541-770-1650