Healthcare Provider Details

I. General information

NPI: 1013081082
Provider Name (Legal Business Name): EASTERN OREGON ORTHOPAEDIC SURGERY & FRACTURE CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 11/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3207 SW PERKINS AVE
PENDLETON OR
97801-3215
US

IV. Provider business mailing address

PO BOX 2714
CORVALLIS OR
97339-2714
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-4642
  • Fax: 541-276-4975
Mailing address:
  • Phone: 541-758-5047
  • Fax: 541-758-3713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMD23266
License Number StateOR

VIII. Authorized Official

Name: DR. BRADLEY SCOTT ADAMS
Title or Position: OWNER
Credential: MD
Phone: 541-276-4642