Provider Demographics
NPI:1730426040
Name:SANTIAM MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:SANTIAM MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRASER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-769-9254
Mailing Address - Street 1:1401 N 10TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:STAYTON
Mailing Address - State:OR
Mailing Address - Zip Code:97383-1487
Mailing Address - Country:US
Mailing Address - Phone:503-769-9455
Mailing Address - Fax:503-769-9316
Practice Address - Street 1:1401 N 10TH AVE
Practice Address - Street 2:STE 200
Practice Address - City:STAYTON
Practice Address - State:OR
Practice Address - Zip Code:97383-1311
Practice Address - Country:US
Practice Address - Phone:503-769-9455
Practice Address - Fax:503-769-9316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty