Healthcare Provider Details

I. General information

NPI: 1548319379
Provider Name (Legal Business Name): UMPQUA ORTHOPEDICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 NW MEDICAL LOOP
ROSEBURG OR
97471-1644
US

IV. Provider business mailing address

277 NW MEDICAL LOOP
ROSEBURG OR
97471-1644
US

V. Phone/Fax

Practice location:
  • Phone: 541-677-2131
  • Fax: 547-677-2136
Mailing address:
  • Phone: 541-677-2131
  • Fax: 547-677-2136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL J KRNACIK
Title or Position: PRESIDENT
Credential: M.D. PH.D.
Phone: 541-677-2131