Provider Demographics
NPI:1417529611
Name:ROGUE COMMUNITY HEALTH
Entity Type:Organization
Organization Name:ROGUE COMMUNITY HEALTH
Other - Org Name:ROGUE COMMUNITY HEALTH DENTAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARNKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-842-7642
Mailing Address - Street 1:1000 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7667
Mailing Address - Country:US
Mailing Address - Phone:541-773-3863
Mailing Address - Fax:
Practice Address - Street 1:11160 HIGHWAY 62 STE A
Practice Address - Street 2:
Practice Address - City:EAGLE POINT
Practice Address - State:OR
Practice Address - Zip Code:97524-8025
Practice Address - Country:US
Practice Address - Phone:541-773-3863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-15
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227698Medicaid