Provider Demographics
NPI: | 1922381326 |
---|---|
Name: | ASANTE PHYSICIAN PARTNERS |
Entity Type: | Organization |
Organization Name: | ASANTE PHYSICIAN PARTNERS |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ASANTE SENIOR VP OF OPERATIONS |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ANGIE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SIMONSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 541-789-4133 |
Mailing Address - Street 1: | 2620 E BARNETT RD |
Mailing Address - Street 2: | SUITE H |
Mailing Address - City: | MEDFORD |
Mailing Address - State: | OR |
Mailing Address - Zip Code: | 97504-8344 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 541-789-2559 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2620 E BARNETT RD |
Practice Address - Street 2: | SUITE H |
Practice Address - City: | MEDFORD |
Practice Address - State: | OR |
Practice Address - Zip Code: | 97504-8344 |
Practice Address - Country: | US |
Practice Address - Phone: | 541-789-4728 |
Practice Address - Fax: | 541-789-4765 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-09-21 |
Last Update Date: | 2024-02-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Single Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Single Specialty | |
No | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | Group - Single Specialty |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Single Specialty |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Single Specialty |
No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Single Specialty | |
No | 207VM0101X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | Group - Single Specialty |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Single Specialty | |
No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Single Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Single Specialty | |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Single Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Single Specialty | |
No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Single Specialty | |
No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Single Specialty | |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OR | R162926 | Medicare Oscar/Certification |