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General NPI Number Information
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NPI Number | 1841286267
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Entity Type | Organization
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Legal Business Name | SURGERY CENTER OF SOUTHERN OREGON, LLC
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Dates
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Enumeration Date | 09/21/2005
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Last Update Date | 02/14/2013
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Provider Practice Location Address
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Address Line | 2798 E BARNETT RD
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City | MEDFORD
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State | OR
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Zip | 97504-8343
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Country | US
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Telephone | 541-858-8100
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Fax | 541-858-0102
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Provider Business Mailing Address
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Address Line | 2798 E BARNETT RD
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City | MEDFORD
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State | OR
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Zip | 97504-8343
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Country | US
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Telephone | 541-858-8100
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Fax | 541-858-0102
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Authorized Official
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Title or Position | EXEC DIRECTOR
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Name | MR. MICHAEL WESTMILLER
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Credential |
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Telephone | 541-858-8100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 07-1509
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License Number State | OR
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