Organization
ROGUE VALLEY SURGICAL ASSISTING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH MILLSAP (OWNER)
(541) 773-2167
Entity
Organization
Contact information
Practice address
2549 SANDY TERRACE, MEDFORD, OR 97504-7723
(541) 773-2167
(541) 773-2167
Mailing address
2549 SANDY TERRACE, MEDFORD, OR 97504-7723
(541) 773-2167
(541) 773-2167
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
292119
—
OR
Enumeration date
07/21/2006
Last updated
08/22/2020
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