Healthcare Provider Details

I. General information

NPI: 1487770483
Provider Name (Legal Business Name): SANTIAM ORTHOPAEDICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1369 N 10TH AVE
STAYTON OR
97383-2037
US

IV. Provider business mailing address

1369 N 10TH AVE
STAYTON OR
97383-2037
US

V. Phone/Fax

Practice location:
  • Phone: 503-769-8470
  • Fax: 503-769-9860
Mailing address:
  • Phone: 503-769-8470
  • Fax: 503-769-9860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD25267
License Number StateOR

VIII. Authorized Official

Name: NICOLAS J STRATTON
Title or Position: OWNER
Credential: M.D.
Phone: 503-769-8470