Provider Demographics
NPI:1558863902
Name:ROGUE VALLEY CHILDRENS PHYSICIANS
Entity Type:Organization
Organization Name:ROGUE VALLEY CHILDRENS PHYSICIANS
Other - Org Name:CHILDREN AND ADOLESCENTS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JERI
Authorized Official - Middle Name:L
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-779-1300
Mailing Address - Street 1:2940 DOCTORS PARK DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8127
Mailing Address - Country:US
Mailing Address - Phone:541-779-1300
Mailing Address - Fax:541-779-9171
Practice Address - Street 1:2940 DOCTORS PARK DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8127
Practice Address - Country:US
Practice Address - Phone:541-779-1300
Practice Address - Fax:541-779-9171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty