Healthcare Provider Details

I. General information

NPI: 1154302214
Provider Name (Legal Business Name): SANTIAM MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N 10TH AVE
STAYTON OR
97383-1485
US

IV. Provider business mailing address

1401 N 10TH AVE
STAYTON OR
97383-1485
US

V. Phone/Fax

Practice location:
  • Phone: 503-769-9215
  • Fax:
Mailing address:
  • Phone: 503-769-2175
  • Fax: 503-769-5877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number14 0709
License Number StateOR

VIII. Authorized Official

Name: MRS. MAGGIE A HUDSON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MBA
Phone: 503-769-9236