Provider Demographics
NPI:1467421404
Name:ROGUE VALLEY UROLOGY, PC
Entity Type:Organization
Organization Name:ROGUE VALLEY UROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-940-7345
Mailing Address - Street 1:1698 E MCANDREWS RD
Mailing Address - Street 2:STE 280
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5589
Mailing Address - Country:US
Mailing Address - Phone:541-774-5808
Mailing Address - Fax:541-732-3910
Practice Address - Street 1:1698 EAST MCANDREWS RD
Practice Address - Street 2:STE 280
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504
Practice Address - Country:US
Practice Address - Phone:541-774-5808
Practice Address - Fax:541-732-3910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR023679000OtherREGENCE BCBS OF OREGON
ORR104271Medicare UPIN