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General NPI Number Information
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NPI Number | 1063400968
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Entity Type | Organization
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Legal Business Name | ALDER MEDICAL CENTER PC
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Dates
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Enumeration Date | 10/13/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 412 ALDER ST
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City | BROOKINGS
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State | OR
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Zip | 97415-9014
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Country | US
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Telephone | 541-469-5919
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Fax | 541-469-6710
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Provider Business Mailing Address
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Address Line | PO BOX 5750
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City | BROOKINGS
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State | OR
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Zip | 97415-0125
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Country | US
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Telephone | 541-469-5919
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Fax | 541-469-6710
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Authorized Official
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Title or Position | PRESIDENT
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Name | KELLY HOUGH LOWTHER
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Credential | MD
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Telephone | 541-469-5919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD22599
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License Number State | OR
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