MEDICARE: CENTRAL OREGON REGIONAL PATHOLOGY SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246QC2700X	Cytotechnology Specialist/Technologist	38D0656805	OR
2	246QH0600X	Histology Specialist/Technologist	38D0656805	OR
3	246R00000X	Pathology Technician	38D0656805	OR
4	291U00000X	Clinical Medical Laboratory	38D0656805	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	346	OTHER	OR	STATE LAB LICENSE NUMBER
2	38D0656805	OTHER	OR	CLIA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649392366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL OREGON REGIONAL PATHOLOGY SERVICES, LLC

Provider Business Mailing Address
First Line	:	1348 NE CUSHING DR STE 210
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-3876
Country	:	US
Telephone Number	:	541-382-7696
Fax Number	:	541-389-5723

Provider Business Practice Location Address
First Line	:	1348 NE CUSHING DR
Second Line	:	SUITE 210
City	:	BEND
State	:	OR
Zip	:	97701-3876
Country	:	US
Telephone Number	:	541-382-7696
Fax Number	:	541-389-5723

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. IRENE CZYSZCZON
Credential	:	DO
Telephone Number	:	541-382-7696

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	05/28/2026

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Directions to “CENTRAL OREGON REGIONAL PATHOLOGY SERVICES, LLC ” Practice Location

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