Provider Demographics
NPI:1134158983
Name:CARDIOVASCULAR INSTITUTE OF SOUTHERN OREGON, LLC
Entity type:Organization
Organization Name:CARDIOVASCULAR INSTITUTE OF SOUTHERN OREGON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT - BOARD OF DIRECTORS
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHNUGG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-282-6660
Mailing Address - Street 1:520 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4334
Mailing Address - Country:US
Mailing Address - Phone:541-282-6660
Mailing Address - Fax:541-282-6661
Practice Address - Street 1:520 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 150
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4334
Practice Address - Country:US
Practice Address - Phone:541-282-6660
Practice Address - Fax:541-282-6661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR247301Medicaid
OR247301Medicaid