Basic Information
| Provider Information | |||||||||
| NPI: | 1760861835 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL OREGON SURGERY CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2460 SW PERKINS AVE | ||||||||
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| City: | PENDLETON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 978014302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8777081119 | ||||||||
| FaxNumber: | 5412788349 | ||||||||
| Practice Location | |||||||||
| Address1: | 1835 NW PENCE LN STE 100 | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977031551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413236184 | ||||||||
| FaxNumber: | 5413236183 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2015 | ||||||||
| LastUpdateDate: | 04/08/2022 | ||||||||
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| AuthorizedOfficialLastName: | REAGAN | ||||||||
| AuthorizedOfficialFirstName: | JESSICA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF HEALTH SYSTEM RCM | ||||||||
| AuthorizedOfficialTelephone: | 5412784340 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0800X | Y | Ambulatory Health Care Facilities | Clinic/Center | Endoscopy |
No ID Information.