Provider Demographics
NPI:1679761944
Name:SKIN CNCR & ENT CENTER
Entity type:Organization
Organization Name:SKIN CNCR & ENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HATFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-245-5400
Mailing Address - Street 1:1698 E MCANDREWS RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5589
Mailing Address - Country:US
Mailing Address - Phone:541-245-5400
Mailing Address - Fax:541-245-5482
Practice Address - Street 1:1698 E MCANDREWS RD
Practice Address - Street 2:SUITE 220
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-5589
Practice Address - Country:US
Practice Address - Phone:541-245-5400
Practice Address - Fax:541-245-5482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR104726Medicare PIN