Healthcare Provider Details

I. General information

NPI: 1225813363
Provider Name (Legal Business Name): CS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 SW BLUFF DR STE A
BEND OR
97702-1283
US

IV. Provider business mailing address

595 SW BLUFF DR STE A
BEND OR
97702-1283
US

V. Phone/Fax

Practice location:
  • Phone: 541-725-2634
  • Fax:
Mailing address:
  • Phone: 541-725-2634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/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: RICHARD ABRAHAM
Title or Position: MBR
Credential: MD
Phone: 541-725-2634