Organization
SOUTHERN OREGON TRAUMA AND EMERGENCY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARVIN D HAAS (CHIEF ADMIN AND FINANCE OFFICER)
(541) 789-4103
Entity
Organization
Contact information
Practice address
2650 SISKIYOU BLVD, SUITE 102, MEDFORD, OR 97504-8170
(541) 789-4728
(541) 789-4765
Mailing address
2650 SISKIYOU BLVD, SUITE 102, MEDFORD, OR 97504-8170
(541) 789-4728
(541) 789-4765
Taxonomy
Speciality
Code
Description
License number
State
261QE0002X
Emergency Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
226953
—
OR
Enumeration date
12/29/2006
Last updated
08/22/2020
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