Provider Demographics
NPI:1255393419
Name:ASHLAND EMERGENCY ASSOCIATES, P.C.
Entity type:Organization
Organization Name:ASHLAND EMERGENCY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/AUTHORIZED GROUP REPRESEN
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ENNS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-488-0679
Mailing Address - Street 1:1995 TOLMAN CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-3697
Mailing Address - Country:US
Mailing Address - Phone:541-488-0679
Mailing Address - Fax:541-552-9690
Practice Address - Street 1:280 MAPLE ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1552
Practice Address - Country:US
Practice Address - Phone:503-482-2441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7094626Medicaid
XGG007121OtherMEDI CAL
38D0969470OtherCLIA WAIVER
CF8926OtherRAILROAD MEDICARE
OR059936Medicaid
OR139457Medicaid
OR023507000OtherBC/BS OF OREGON
126727OtherWASHINGTON LABOR AND INDU
453217001OtherGROUP HEALTH
OR059936Medicaid