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NPI Code Detail

MEDICARE: ROGUE VALLEY MANOR, INC

MEDICARE: ROGUE VALLEY MANOR, INC
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
1207Q00000XFamily Medicine Physician
2207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1780634808
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROGUE VALLEY MANOR, INC
Provider Business Mailing Address
First Line : 1208 BEALL LN
Second Line :
City : CENTRAL POINT
State : OR
Zip : 97502-1573
Country : US
Telephone Number : 541-857-7133
Fax Number : 541-857-7594
Provider Business Practice Location Address
First Line : 1200 MIRA MAR AVE
Second Line :
City : MEDFORD
State : OR
Zip : 97504-8546
Country : US
Telephone Number : 541-857-7133
Fax Number : 541-857-7594
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : SARAH E SMITH
Credential :
Telephone Number : 541-587-7133
Provider Enumeration Date : 05/11/2006
Last Update Date : 07/16/2013

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Directions to “ROGUE VALLEY MANOR, INC ” Practice Location

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