| Organization Name: | SANTIAM MEDICAL GROUP LLC |
| NPI Number: | 1083943617 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LYNDA FRASER (CLINIC COORDINATOR) |
| Mailing Address: | 1375 N 10th Ave Suite B Stayton |
| State: | OR US |
| Postal Code: | 973832037 |
| Phone Number: | 5037697546 |
| Fax Number: | 5037698563 |
| NPI Enumeration Date: | 12/10/2009 |
| NPI Last Update Date: | 10/15/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |