Provider Demographics
NPI:1104082577
Name:CANCER CARE OF SOUTHERN OREGON
Entity type:Organization
Organization Name:CANCER CARE OF SOUTHERN OREGON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:FLINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-282-2208
Mailing Address - Street 1:748 STATE ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8473
Mailing Address - Country:US
Mailing Address - Phone:541-772-5282
Mailing Address - Fax:541-282-2237
Practice Address - Street 1:2900 DOCTORS PARK DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8198
Practice Address - Country:US
Practice Address - Phone:541-282-2208
Practice Address - Fax:541-282-2237
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROGUE VALLEY PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR105049Medicare PIN