Organization
ASHLAND EMERGENCY ASSOCIATES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GORDON LEE ENNS M.D. (PRESIDENT/AUTHORIZED GROUP REPRESEN)
(541) 488-0679
Entity
Organization
Contact information
Practice address
280 MAPLE ST, ASHLAND, OR 97520-1552
(503) 482-2441
Mailing address
1995 TOLMAN CREEK ROAD, ASHLAND, OR 97520-3697
(541) 488-0679
(541) 552-9690
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
023507000
BC/BS OF OREGON
OR
05
—
059936
—
OR
01
—
126727
WASHINGTON LABOR AND INDU
—
05
—
139457
—
OR
01
—
38D0969470
CLIA WAIVER
—
01
—
453217001
GROUP HEALTH
—
05
—
7094626
—
WA
01
—
CF8926
RAILROAD MEDICARE
—
01
—
XGG007121
MEDI CAL
—
Enumeration date
04/04/2006
Last updated
07/18/2015
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