Provider Demographics
NPI:1558358721
Name:HEART CLINIC OF SOUTHERN OREGON & NORTHERN CALIFORNIA PC
Entity Type:Organization
Organization Name:HEART CLINIC OF SOUTHERN OREGON & NORTHERN CALIFORNIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:DAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-282-6620
Mailing Address - Street 1:520 MEDICAL CENTER DR
Mailing Address - Street 2:STE 200
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4334
Mailing Address - Country:US
Mailing Address - Phone:541-282-6600
Mailing Address - Fax:541-282-6608
Practice Address - Street 1:520 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4314
Practice Address - Country:US
Practice Address - Phone:541-282-6600
Practice Address - Fax:541-282-6608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR130327Medicaid
ORCG2868OtherRAILROAD MEDICARE
ORCG2868OtherRAILROAD MEDICARE