Healthcare Provider Details

I. General information

NPI: 1346993649
Provider Name (Legal Business Name): RBD SOUTHERN OREGON HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8336 HIGHWAY 62 # 101
WHITE CITY OR
97503-1024
US

IV. Provider business mailing address

2950 E BARNETT RD
MEDFORD OR
97504-8309
US

V. Phone/Fax

Practice location:
  • Phone: 541-826-7410
  • Fax:
Mailing address:
  • Phone: 541-826-7410
  • Fax:

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: KARISSA STULTS
Title or Position: DIRECTOR OF BILLING
Credential:
Phone: 541-890-5217