=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609715689
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YMCA OF MEDFORD, OREGON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2026
-----------------------------------------------------
Last Update Date | 03/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 522 W. 6TH STREET
-----------------------------------------------------
City | MEDFORD
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-772-6295
-----------------------------------------------------
Fax | 541-772-8427
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 522 W. 6TH STREET
-----------------------------------------------------
City | MEDFORD
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-772-6295
-----------------------------------------------------
Fax | 541-772-8427
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. BRADFORD WINSOR RUSSELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 541-772-6295
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251V00000X
-----------------------------------------------------
Taxonomy Name | Voluntary or Charitable Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------