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PROVIDENCE MEDFORD MEDICAL CENTER
NPI 1013944776
Clinic/Center - Emergency Care in Medford, OR

Active since June 27, 2006CLIA Certified · 2 labs
1111 CRATER LAKE AVENUE, MEDFORD, OR 97504(541) 732-5000(541) 732-5131 Get Directions Write a Review

NPPES record last updated: May 7, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Providence Medford Medical Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVIDENCE MEDFORD MEDICAL CENTER (NPI 1013944776), doing business as Providence Medford Medical Center Lifeline, is a healthcare organization registered as an emergency care in Medford, Oregon and active in the NPI registry since June 2006. The organization holds 2 active CLIA laboratory certificates and lists Donald W Anderson, Assistant Secretary Enrollments, as its authorized official.

NPPES Registry Identity

NPI1013944776
Entity TypeOrganization
Primary Taxonomy261QE0002X
Legal Business NamePROVIDENCE MEDFORD MEDICAL CENTER
Location Address1111 CRATER LAKE AVENUEMedford, OR 97504-6214
Mailing AddressP.o. Box 3308Portland, OR 97208-3308 · (503) 215-4050 · Fax (503) 215-4343
Phone(541) 732-5000
Fax(541) 732-5131
Organization SubpartNo
Authorized OfficialDonald W AndersonAssistant Secretary Enrollments · (425) 358-9786
Enumeration DateJune 27, 2006
Last NPPES UpdateMay 7, 2025
NPPES CertifiedMay 7, 2025
✔ NPI 1013944776 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Emergency CareAmbulatory Health Care Facilities
Taxonomy Code261QE0002X
Also ListedGeneral Acute Care HospitalTaxonomy 282N00000X · License 140734 (OR)
1111 CRATER LAKE AVENUE, Medford, OR 97504
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Other Names 1

Doing Business AsProvidence Medford Medical Center Lifeline

Other Identifiers 1

Medicaid227950OR

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Accreditation 38D0627783

Providence Medford Medical Center Laboratory · Medford, OR
Active · expires Dec 31, 2027
CLIA Number38D0627783
Laboratory TypeHospital
Certificate Effective DateJanuary 1, 2026
Certificate Expiration DateDecember 31, 2027
Laboratory DirectorMathew Greenberg
Laboratory Phone(541) 732-6165
Laboratory LocationProvidence Medford Medical Center Laboratory1111 Crater Lake Ave, Medford, OR 97504
CLIA data matches this NPI record on: Address Name
This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Certificate of Waiver 38D2146686

Providence Medford Medical Center Anticoagulation And Pharmacotherapy Clinic · Medford, OR
Active · expires Apr 3, 2028
CLIA Number38D2146686
Laboratory TypeAncillary Testing Site In Health Care Center
Certificate Effective DateApril 4, 2026
Certificate Expiration DateApril 3, 2028
Laboratory DirectorKelley Dunlop
Laboratory Phone(541) 732-3271
Laboratory LocationProvidence Medford Medical Center Anticoagulation And Pharmacotherapy Clinic1698 E Mcandrews Rd, Suite 220, Medford, OR 97504
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Providence Medford Medical Center's NPI number?

The NPI number for Providence Medford Medical Center is 1013944776. It was assigned to this organization in the NPPES registry on June 27, 2006. The provider is doing business as Providence Medford Medical Center Lifeline.

Where is Providence Medford Medical Center located?

Providence Medford Medical Center is located at 1111 Crater Lake Avenue, Medford, OR 97504. The listed phone number is (541) 732-5000.

What is Providence Medford Medical Center's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Emergency Care, with taxonomy code 261QE0002X.

Does Providence Medford Medical Center hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Providence Medford Medical Center was last updated on May 7, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.