Provider Demographics
NPI:1578658290
Name:ASHLAND MEDICAL SERVICES, INC
Entity Type:Organization
Organization Name:ASHLAND MEDICAL SERVICES, INC
Other - Org Name:SO. ORE. MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:WYATT
Authorized Official - Last Name:CROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-324-3880
Mailing Address - Street 1:2305 ASHLAND ST
Mailing Address - Street 2:PMB 448
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-3777
Mailing Address - Country:US
Mailing Address - Phone:541-773-5994
Mailing Address - Fax:541-773-6015
Practice Address - Street 1:1600 E BARNETT RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8283
Practice Address - Country:US
Practice Address - Phone:541-773-5994
Practice Address - Fax:541-773-6015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR07-00028954332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR006035Medicaid
OR872666000OtherREGENCE BC/BS PPP/PC #
OR200409101OtherREGENCE BC/BS PC 65 #
OR872666000OtherREGENCE BC/BS PPP/PC #