Healthcare Provider Details

I. General information

NPI: 1912413147
Provider Name (Legal Business Name): SANTIAM MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2017
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1369 N 10TH AVE
STAYTON OR
97383
US

IV. Provider business mailing address

1369 N 10TH AVE
STAYTON OR
97383-2037
US

V. Phone/Fax

Practice location:
  • Phone: 503-769-7960
  • Fax: 503-769-2172
Mailing address:
  • Phone: 503-769-7960
  • Fax: 503-769-2172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LYNDA FRASER
Title or Position: CLINIC DIRECTOR
Credential:
Phone: 503-769-9254