Healthcare Provider Details

I. General information

NPI: 1235706185
Provider Name (Legal Business Name): SANTIAM MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 06/09/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N 10TH AVE
STAYTON OR
97383-1311
US

IV. Provider business mailing address

1401 N 10TH AVE
STAYTON OR
97383-1311
US

V. Phone/Fax

Practice location:
  • Phone: 503-769-9307
  • Fax: 503-769-8692
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LYNDA FRASER
Title or Position: MEDICAL CLINICS QUALITY COORDINATOR
Credential:
Phone: 503-769-9254