Basic Information
Provider Information | |||||||||
NPI: | 1326085846 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RUTH | ||||||||
FirstName: | MARY | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | FNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2051 KAEN RD STE 367 | ||||||||
Address2: |   | ||||||||
City: | OREGON CITY | ||||||||
State: | OR | ||||||||
PostalCode: | 970454035 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5037425300 | ||||||||
FaxNumber: | 5036558429 | ||||||||
Practice Location | |||||||||
Address1: | 1445 GATEWAY BLVD | ||||||||
Address2: |   | ||||||||
City: | COTTAGE GROVE | ||||||||
State: | OR | ||||||||
PostalCode: | 974241224 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5419427000 | ||||||||
FaxNumber: | 5419425550 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/01/2006 | ||||||||
LastUpdateDate: | 01/10/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 200050114NP | OR | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   | 363LF0000X | 200050114NP | OR | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LP2300X | 200050114NP | OR | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
ID Information
ID | Type | State | Issuer | Description | R0000ZGBDG | 01 | OR | CURRY GENERAL HOSPITAL'S MEDICARE PART B | OTHER | 1487696985 | 01 | OR | CURRY GENERAL HOSPITAL NPI | OTHER | 1811939093 | 01 | OR | CURRY FAMILY MEDICAL NPI | OTHER | 200050114NP | 01 | OR | STATE LICENSE | OTHER | 381322 | 01 | OR | CURRY GENERAL HOSPITAL'S MEDICARE PART A | OTHER |