# STAYTON FAMILY PRACTICE INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Jefferson Medical Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285967133
- **Authorized official:** DR. LANCE B LARGE MD (OWNER)
- **Authorized official phone:** (503) 400-6140

## Contact information

- **Practice address:** 294 2ND ST N, JEFFERSON, OR 97352
- **Practice address phone:** (541) 327-2380
- **Practice address fax:** (541) 327-2382
- **Mailing address:** 1881 W WASHINGTON ST, STAYTON, OR 97383-9511
- **Mailing address phone:** (503) 400-6140
- **Mailing address fax:** (503) 769-3797

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/10/2009
- **Last updated:** 06/15/2022