Provider Demographics
NPI:1497935985
Name:ASANTE
Entity Type:Organization
Organization Name:ASANTE
Other - Org Name:ROGUE VALLEY MEDICAL CENTER OUTPATIENT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAFO
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-789-4103
Mailing Address - Street 1:2825 E BARNETT RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8332
Mailing Address - Country:US
Mailing Address - Phone:541-789-7000
Mailing Address - Fax:
Practice Address - Street 1:2825 E BARNETT RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8332
Practice Address - Country:US
Practice Address - Phone:541-789-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR4963900004OtherMEDICARE DMERCK
OR120451Medicaid