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General NPI Number Information
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NPI Number | 1750252185
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Entity Type | Organization
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Legal Business Name | UMPQUA VALLEY SURGERY CENTER LLC
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Dates
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Enumeration Date | 09/17/2025
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 341 NW MEDICAL LOOP STE 100
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City | ROSEBURG
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State | OR
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Zip | 97471-5546
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Country | US
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Telephone | 541-672-8288
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Fax |
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Provider Business Mailing Address
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Address Line | 341 NW MEDICAL LOOP STE 100
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City | ROSEBURG
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State | OR
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Zip | 97471-5546
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Country | US
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Telephone | 541-672-8288
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Fax |
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Authorized Official
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Title or Position | IMPLEMENTATION MANAGER
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Name | JACKIE WIEDEMANN
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Credential |
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Telephone | 816-610-8511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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