=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912160532
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SANTIAM MEDICAL ASSOCIATES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2008
-----------------------------------------------------
Last Update Date | 08/25/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1401 N TENTH AVE SUITE 100
-----------------------------------------------------
City | STAYTON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97383-1486
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-769-6386
-----------------------------------------------------
Fax | 503-769-5647
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1401 N TENTH AVE SUITE 100
-----------------------------------------------------
City | STAYTON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97383-1486
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-769-6386
-----------------------------------------------------
Fax | 503-769-5647
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. PAUL JAY NEUMANN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 503-769-6386
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------