| Pmg South Medford Pediatrics | |
|
840 Royal Ave Suite 110 Medford OR 97504-6461 | |
| (541) 732-8370 | |
| (541) 732-8371 |
| Full Name | Pmg South Medford Pediatrics |
|---|---|
| Speciality | Clinic/center |
| Location | 840 Royal Ave, Medford, Oregon |
| Authorized Official Name and Position | Donald W Anderson (DIR REIMB REG STRAT/ASST SEC ENROLL) |
| Authorized Official Contact | 4255255392 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pmg South Medford Pediatrics Po Box 3158 Portland OR 97208-3158 Ph: (503) 215-6494 | Pmg South Medford Pediatrics 840 Royal Ave Suite 110 Medford OR 97504-6461 Ph: (541) 732-8370 |
| NPI Number | 1316024128 |
|---|---|
| Provider Enumeration Date | 11/01/2006 |
| Last Update Date | 06/15/2021 |
| Certification Date | 06/15/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316024128 | NPI | - | NPPES |
| CG6801 | Other | OR | RAIL ROAD MEDICARE |
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