Provider Demographics
NPI:1477909570
Name:SANTIAM MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:SANTIAM MEMORIAL HOSPITAL
Other - Org Name:SANTIAM MEDICAL ASSOCIATES
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 1:1401 N 10TH AVE
Mailing Address - Street 2:STE. 100
Mailing Address - City:STAYTON
Mailing Address - State:OR
Mailing Address - Zip Code:97383-1486
Mailing Address - Country:US
Mailing Address - Phone:503-769-6386
Mailing Address - Fax:503-769-5647
Practice Address - Street 1:1401 N 10TH AVE
Practice Address - Street 2:STE. 100
Practice Address - City:STAYTON
Practice Address - State:OR
Practice Address - Zip Code:97383-1486
Practice Address - Country:US
Practice Address - Phone:503-769-6386
Practice Address - Fax:503-769-5647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care