Provider Demographics
NPI:1801829346
Name:MEDFORD WOMENS CLINIC LLP
Entity Type:Organization
Organization Name:MEDFORD WOMENS CLINIC LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE LEAD
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-864-8906
Mailing Address - Street 1:3170 STATE ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8450
Mailing Address - Country:US
Mailing Address - Phone:541-864-8900
Mailing Address - Fax:541-245-3315
Practice Address - Street 1:3170 STATE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8450
Practice Address - Country:US
Practice Address - Phone:541-864-8900
Practice Address - Fax:541-245-3315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2022-12-06
Deactivation Date:2022-11-10
Deactivation Code:
Reactivation Date:2022-12-06
Provider Licenses
StateLicense IDTaxonomies
OR207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty