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General NPI Number Information
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NPI Number | 1154093847
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Entity Type | Organization
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Legal Business Name | BA VENTURES LLC
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Dates
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Enumeration Date | 09/30/2021
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Last Update Date | 07/12/2023
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Provider Practice Location Address
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Address Line | 2435 NW KLINE ST
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City | ROSEBURG
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State | OR
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Zip | 97471-1687
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Country | US
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Telephone | 541-673-8182
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Fax | 541-673-9083
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Provider Business Mailing Address
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Address Line | 2435 NW KLINE ST
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City | ROSEBURG
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State | OR
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Zip | 97471-1687
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Country | US
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Telephone | 541-343-5000
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | BALA AMBATI
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Credential | MD
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Telephone | 541-343-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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