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1255393419

NPI Code Detail

MEDICARE: ASHLAND EMERGENCY ASSOCIATES, P.C.

MEDICARE: ASHLAND EMERGENCY ASSOCIATES, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	CF8926	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	XGG007121	OTHER		MEDI CAL
3	38D0969470	OTHER		CLIA WAIVER
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	023507000	OTHER	OR	BC/BS OF OREGON
8	126727	OTHER		WASHINGTON LABOR AND INDU
9	453217001	OTHER		GROUP HEALTH

General Provider Information

NPI Number	:	1255393419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASHLAND EMERGENCY ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	1995 TOLMAN CREEK ROAD
Second Line	:
City	:	ASHLAND
State	:	OR
Zip	:	97520-3697
Country	:	US
Telephone Number	:	541-488-0679
Fax Number	:	541-552-9690

Provider Business Practice Location Address
First Line	:	280 MAPLE ST
Second Line	:
City	:	ASHLAND
State	:	OR
Zip	:	97520-1552
Country	:	US
Telephone Number	:	503-482-2441
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/AUTHORIZED GROUP REPRESEN
Name	:	DR. GORDON LEE ENNS
Credential	:	M.D.
Telephone Number	:	541-488-0679

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	07/18/2015

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Directions to “ASHLAND EMERGENCY ASSOCIATES, P.C. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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