Healthcare Provider Details

I. General information

NPI: 1053595603
Provider Name (Legal Business Name): NORTHEAST OREGON SURGICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2474 S.W. PERKINS AVE
PENDLETON OR
97801
US

IV. Provider business mailing address

2474 S. W. PERKINS AVE
PENDLETON OR
97801
US

V. Phone/Fax

Practice location:
  • Phone: 541-966-1001
  • Fax: 541-966-1195
Mailing address:
  • Phone: 541-966-1001
  • Fax: 541-966-1195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD26075
License Number StateOR

VIII. Authorized Official

Name: MR. ANDREW L BOWER
Title or Position: GENERAL SURGEON
Credential: M.D.
Phone: 541-966-1001