Healthcare Provider Details

I. General information

NPI: 1780916478
Provider Name (Legal Business Name): SANTIAM MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2010
Last Update Date: 02/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N 10TH AVE SUITE 200
STAYTON OR
97383-1311
US

IV. Provider business mailing address

1401 N 10TH AVE SUITE 200
STAYTON OR
97383-1311
US

V. Phone/Fax

Practice location:
  • Phone: 503-769-9070
  • Fax: 503-769-5416
Mailing address:
  • Phone: 503-769-9070
  • Fax: 503-769-5416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

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