Organization
RIVER ROCK FAMILY PRACTICE PC
Active
Parent organization
RIVER ROCK FAMILY PRACTICE PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
RIVER ROCK FAMILY PRACTICE PC
Authorized official
TAMMY HARRISON (SECRETARY)
(541) 226-9840
Entity
Organization
Contact information
Practice address
3144 STATE ST, MEDFORD, OR 97504-8450
(541) 226-9840
Mailing address
3144 STATE ST, MEDFORD, OR 97504-8450
(541) 226-9840
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
026845
DMAP
OR
01
—
1356355846
NPI INDIVIDUAL
OR
01
—
200550153NP
FNPC
OR
Enumeration date
11/22/2019
Last updated
03/07/2023
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