Provider Demographics
NPI:1316288616
Name:ROGUE COMMUNITY HEALTH
Entity type:Organization
Organization Name:ROGUE COMMUNITY HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CALISA
Authorized Official - Middle Name:N
Authorized Official - Last Name:WARNKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-842-7642
Mailing Address - Street 1:900 EAST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504
Mailing Address - Country:US
Mailing Address - Phone:541-842-7747
Mailing Address - Fax:541-842-7637
Practice Address - Street 1:19 MYRTLE STREET
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504
Practice Address - Country:US
Practice Address - Phone:541-842-7747
Practice Address - Fax:541-842-7637
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROGUE COMMUNITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-12
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRP0002740CS3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3844607OtherNCPDP PROVIDER IDENTIFICATION NUMBER
OR227698Medicaid
OR500667341Medicaid