Provider Demographics
NPI:1225225709
Name:SANTIAM MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:SANTIAM MEMORIAL HOSPITAL
Other - Org Name:SUBLIMITY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRASER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-769-9254
Mailing Address - Street 1:PO BOX 886
Mailing Address - Street 2:
Mailing Address - City:SUBLIMITY
Mailing Address - State:OR
Mailing Address - Zip Code:97385-0886
Mailing Address - Country:US
Mailing Address - Phone:503-769-2259
Mailing Address - Fax:
Practice Address - Street 1:114 SE CHURCH ST
Practice Address - Street 2:
Practice Address - City:SUBLIMITY
Practice Address - State:OR
Practice Address - Zip Code:97385-9714
Practice Address - Country:US
Practice Address - Phone:503-769-2259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care