Healthcare Provider Details

I. General information

NPI: 1194769299
Provider Name (Legal Business Name): EASTERN OREGON ORTHOPAEDIC SURGERY & FRACTURE CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3207 SW PERKINS AVE
PENDLETON OR
97801-3215
US

IV. Provider business mailing address

3207 SW PERKINS AVE
PENDLETON OR
97801-4465
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-4642
  • Fax: 541-276-4975
Mailing address:
  • Phone: 541-276-4642
  • Fax: 541-276-4975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number157239-92
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: WHITNEY MARIE JONES
Title or Position: OFFICE MANAGER
Credential:
Phone: 541-276-4642