Healthcare Provider Details

I. General information

NPI: 1811920366
Provider Name (Legal Business Name): MIDDLE FORK SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 S GARDEN WAY SUITE 100
EUGENE OR
97401-8173
US

IV. Provider business mailing address

360 S GARDEN WAY SUITE 100
EUGENE OR
97401-8173
US

V. Phone/Fax

Practice location:
  • Phone: 541-334-0488
  • Fax:
Mailing address:
  • Phone: 541-334-0488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain 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: ROBERT GESSELE
Title or Position: ADMINISTRATOR
Credential:
Phone: 541-334-0488