Healthcare Provider Details

I. General information

NPI: 1720235070
Provider Name (Legal Business Name): SYNERGY MEDICAL SYSTEMS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 05/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 COBURG RD SUITE 106
EUGENE OR
97401-2433
US

IV. Provider business mailing address

1710 WILLOW CREEK CIR SUITE 1
EUGENE OR
97402-9192
US

V. Phone/Fax

Practice location:
  • Phone: 541-342-4925
  • Fax:
Mailing address:
  • Phone: 541-343-3758
  • Fax: 541-342-3341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number258017-96
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: BRIAN PAUL BAUMGARTNER
Title or Position: PRESIDENT
Credential:
Phone: 541-343-3758