Healthcare Provider Details

I. General information

NPI: 1912160532
Provider Name (Legal Business Name): SANTIAM MEDICAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 08/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N TENTH AVE SUITE 100
STAYTON OR
97383-1486
US

IV. Provider business mailing address

1401 N TENTH AVE SUITE 100
STAYTON OR
97383-1486
US

V. Phone/Fax

Practice location:
  • Phone: 503-769-6386
  • Fax: 503-769-5647
Mailing address:
  • Phone: 503-769-6386
  • Fax: 503-769-5647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. PAUL JAY NEUMANN
Title or Position: OWNER
Credential: MD
Phone: 503-769-6386