Healthcare Provider Details

I. General information

NPI: 1285965798
Provider Name (Legal Business Name): ROGUE COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 E MCANDREWS RD STE 202
MEFORD OR
97504-6177
US

IV. Provider business mailing address

1000 E MAIN STREET
MEDFORD OR
97504
US

V. Phone/Fax

Practice location:
  • Phone: 541-773-3688
  • Fax: 541-773-3125
Mailing address:
  • Phone: 541-773-3863
  • Fax: 541-930-5572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier227698
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: CALISA N WARNKE
Title or Position: CFO
Credential:
Phone: 541-842-7642