Healthcare Provider Details

I. General information

NPI: 1477949766
Provider Name (Legal Business Name): DESCHUTES SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 NE WYATT CT SUITE 105
BEND OR
97701-7678
US

IV. Provider business mailing address

2115 NE WYATT CT SUITE 105
BEND OR
97701-7678
US

V. Phone/Fax

Practice location:
  • Phone: 541-585-2400
  • Fax: 541-585-2415
Mailing address:
  • Phone: 541-585-2400
  • Fax: 541-585-2415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KIMBERLY M BOOHER
Title or Position: ADMINISTRATOR
Credential: BS
Phone: 541-585-2400