Healthcare Provider Details

I. General information

NPI: 1922003052
Provider Name (Legal Business Name): EAST OREGON SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 SOUTHGATE STE B
PENDLETON OR
97801-3953
US

IV. Provider business mailing address

1050 SOUTHGATE STE B
PENDLETON OR
97801-3953
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-3212
  • Fax: 541-278-8003
Mailing address:
  • Phone: 541-276-3212
  • Fax: 541-278-8003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number071538
License Number StateOR

VIII. Authorized Official

Name: BART A ADAMS
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 541-276-3212