Provider Demographics
NPI:1922582493
Name:OASIS CENTER OF THE ROGUE VALLEY
Entity Type:Organization
Organization Name:OASIS CENTER OF THE ROGUE VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HECOX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-200-1530
Mailing Address - Street 1:PO BOX 1187
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501
Mailing Address - Country:US
Mailing Address - Phone:541-200-1530
Mailing Address - Fax:541-772-0284
Practice Address - Street 1:534 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504
Practice Address - Country:US
Practice Address - Phone:541-200-1530
Practice Address - Fax:541-772-0284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-20
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500196061Medicaid
OR500759333Medicaid