Provider Demographics
NPI:1861459828
Name:ONCOLOGY OF SOUTHERN OREGON LLC
Entity Type:Organization
Organization Name:ONCOLOGY OF SOUTHERN OREGON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:NOYCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-772-5282
Mailing Address - Street 1:748 STATE ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8473
Mailing Address - Country:US
Mailing Address - Phone:541-282-8888
Mailing Address - Fax:541-282-8898
Practice Address - Street 1:748 STATE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8473
Practice Address - Country:US
Practice Address - Phone:541-282-8888
Practice Address - Fax:541-282-8898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR3988910001OtherDEMERC
OR227273Medicaid
OR3988910001OtherDEMERC