Healthcare Provider Details

I. General information

NPI: 1114395779
Provider Name (Legal Business Name): NEUROMUSCULOSKELETAL CENTER OF THE CASCADES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 SW BOND ST
BEND OR
97702-3593
US

IV. Provider business mailing address

2200 NE NEFF RD SUITE 200
BEND OR
97701-4283
US

V. Phone/Fax

Practice location:
  • Phone: 541-382-3344
  • Fax: 541-382-1681
Mailing address:
  • Phone: 541-382-3344
  • Fax: 541-382-1681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD24633
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier38D2009896
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerCLIA
# 2
Identifier134170
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: MR. BRETT HAZLETT
Title or Position: CEO
Credential:
Phone: 541-322-2379