Healthcare Provider Details

I. General information

NPI: 1750261392
Provider Name (Legal Business Name): SANTIAM MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 S 1ST AVE STE A
MILL CITY OR
97360-1404
US

IV. Provider business mailing address

PO BOX 577
STAYTON OR
97383-0577
US

V. Phone/Fax

Practice location:
  • Phone: 503-769-9255
  • Fax:
Mailing address:
  • Phone: 503-769-9255
  • Fax: 503-769-3472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: CASSONDRA POSVAR
Title or Position: EXECUTIVE DIRECTOR OF REVENUE AND R
Credential:
Phone: 503-769-9255