Provider Demographics
NPI:1992541296
Name:SOUTHERN OREGON FAMILY MEDICINE LLC
Entity type:Organization
Organization Name:SOUTHERN OREGON FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOYES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:541-840-8487
Mailing Address - Street 1:5005 TOLO RD
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-9335
Mailing Address - Country:US
Mailing Address - Phone:541-840-8487
Mailing Address - Fax:
Practice Address - Street 1:5005 TOLO RD
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-9335
Practice Address - Country:US
Practice Address - Phone:541-840-8487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty