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ROGUE VALLEY MANOR, INC
NPI 1780634808
Internal Medicine in Medford, OR

Active since May 11, 2006CLIA 38D0724553 · Waiver
1200 MIRA MAR AVE, MEDFORD, OR 97504(541) 857-7133(541) 857-7594 Get Directions Write a Review

NPPES record last updated: March 3, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 3, 2026, Dec 29, 2025 (2 updates tracked since 2025).

About Rogue Valley Manor, Inc NPPES

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

ROGUE VALLEY MANOR, INC (NPI 1780634808) is a healthcare organization registered as an internal medicine in Medford, Oregon and active in the NPI registry since May 2006. The organization holds a CLIA Waiver certificate valid through December 31, 2027 and lists Melissa Preston, Associate Executive Director, as its authorized official.

NPPES Registry Identity

NPI1780634808
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameROGUE VALLEY MANOR, INC
Location Address1200 MIRA MAR AVEMedford, OR 97504-8546
Mailing Address1200 Mira Mar AveMedford, OR 97504-8546 · (541) 857-7133 · Fax (541) 857-7594
Phone(541) 857-7133
Fax(541) 857-7594
Organization SubpartYesParent: Rogue Valley Manor
Authorized OfficialMelissa PrestonAssociate Executive Director · (541) 857-7392
Enumeration DateMay 11, 2006
Last NPPES UpdateMarch 3, 20262 updates tracked since enumeration
NPPES CertifiedMarch 3, 2026
✔ NPI 1780634808 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Also ListedFamily MedicineTaxonomy 207Q00000X
1200 MIRA MAR AVE, Medford, OR 97504
Open in Google Maps ↗

Other Names 1

Other NameRogue Valley Manor Clinic

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

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 Waiver 38D0724553

Rogue Valley Manor · Medford, OR
Active · expires Dec 31, 2027
CLIA Number38D0724553
Laboratory TypePhysician Office
Certificate Effective DateJanuary 1, 2026
Certificate Expiration DateDecember 31, 2027
Laboratory DirectorMelissa Preston
Laboratory Phone(541) 857-7133
Laboratory LocationRogue Valley Manor1250 Mira Mar Ave, Medford, OR 97504
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KELLY ANN REID
Speech-Language Pathologist
1200 MIRA MAR AVE
MEDFORD, OR 97504
Jackson County (541) 848-7868
MATTHEW G HARMESTON
Physical Therapy Assistant
1200 MIRA MAR AVE
MEDFORD, OR 97504
Jackson County (541) 857-7777
ERIN TYLER BAYNE DPT
Physical Therapist
1200 MIRA MAR AVE
MEDFORD, OR 97504
Jackson County (425) 737-0482
SUSAN BASILICATO NP
Registered Nurse (General Practice)
1200 MIRA MAR AVE
MEDFORD, OR 97504
Jackson County (541) 664-5151
MR. PETER KRALIK COTA
Occupational Therapy Assistant
1200 MIRA MAR AVE, ROGUE VALLEY MANOR
MEDFORD, OR 97504
Jackson County (541) 857-7432
JUNNE LICATA
Physical Therapy Assistant
1200 MIRA MAR AVE
MEDFORD, OR 97504
Jackson County (541) 857-7131
LISA M JOHNSTON LMT
Massage Therapist
1200 MIRA MAR AVE, C/O EMA'S SALON
MEDFORD, OR 97504
Jackson County (541) 857-7365
KAREN A CAMPBELL PTA
Physical Therapy Assistant
1200 MIRA MAR AVE
MEDFORD, OR 97504
Jackson County (800) 848-7868

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 Rogue Valley Manor, Inc's NPI number?

The NPI number for Rogue Valley Manor, Inc is 1780634808. It was assigned to this organization in the NPPES registry on May 11, 2006. The provider is also known as Rogue Valley Manor Clinic.

Where is Rogue Valley Manor, Inc located?

Rogue Valley Manor, Inc is located at 1200 Mira Mar Ave, Medford, OR 97504. The listed phone number is (541) 857-7133.

What is Rogue Valley Manor, Inc's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does Rogue Valley Manor, Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 38D0724553) is associated with this NPI, valid through December 31, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Rogue Valley Manor, Inc was last updated on March 3, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.