Provider Demographics
NPI:1003982281
Name:UMPQUA MEDICAL PC
Entity Type:Organization
Organization Name:UMPQUA MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:OTTENHEIMER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:541-673-0496
Mailing Address - Street 1:2880 NW STEWART PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-1201
Mailing Address - Country:US
Mailing Address - Phone:541-673-0496
Mailing Address - Fax:541-673-5794
Practice Address - Street 1:2880 NW STEWART PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1201
Practice Address - Country:US
Practice Address - Phone:541-673-0496
Practice Address - Fax:541-673-5794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR100807Medicare ID - Type Unspecified