Basic Information
Provider Information
NPI: 1871621623
EntityType: 2
ReplacementNPI:  
OrganizationName: CHETCO ANESTHESIA SERVICES LLC
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Mailing Information
Address1: PO BOX 8021
Address2:  
City: BROOKINGS
State: OR
PostalCode: 974150376
CountryCode: US
TelephoneNumber: 5036504359
FaxNumber: 5036506913
Practice Location
Address1: 648 CHETCO AVE
Address2:  
City: BROOKINGS
State: OR
PostalCode: 97415
CountryCode: US
TelephoneNumber: 5036504359
FaxNumber: 5036506913
Other Information
ProviderEnumerationDate: 03/02/2007
LastUpdateDate: 07/23/2007
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AuthorizedOfficialLastName: RUSH
AuthorizedOfficialFirstName: JOHN
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AuthorizedOfficialTitleorPosition: CEO
AuthorizedOfficialTelephone: 5036504359
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IsOrganizationSubpart: N
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AuthorizedOfficialCredential: DO
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X ORN193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansAnesthesiology 
367500000X ORY193200000X MULTI-SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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