Provider Demographics
NPI:1275049850
Name:SANTIAM MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:SANTIAM MEMORIAL HOSPITAL
Other - Org Name:SANTIAM PULMONARY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/COO
Authorized Official - Prefix:
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-769-9236
Mailing Address - Street 1:1401 N 10TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:STAYTON
Mailing Address - State:OR
Mailing Address - Zip Code:97383-1487
Mailing Address - Country:US
Mailing Address - Phone:503-769-9455
Mailing Address - Fax:503-769-9316
Practice Address - Street 1:1401 N 10TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:STAYTON
Practice Address - State:OR
Practice Address - Zip Code:97383
Practice Address - Country:US
Practice Address - Phone:503-769-9455
Practice Address - Fax:503-769-9316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty