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General NPI Number Information
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NPI Number | 1164814471
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Entity Type | Organization
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Legal Business Name | CELILO SURGICAL LLC
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Dates
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Enumeration Date | 02/24/2015
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Last Update Date | 05/13/2015
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Provider Practice Location Address
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Address Line | 1810 E 19TH ST STE 225
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City | THE DALLES
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State | OR
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Zip | 97058-3388
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Country | US
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Telephone | 541-296-6101
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Fax | 541-296-0025
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Provider Business Mailing Address
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Address Line | 1810 E 19TH ST STE 225
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City | THE DALLES
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State | OR
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Zip | 97058-3388
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Country | US
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Telephone | 541-296-6101
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Fax | 541-296-0025
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | KARI GUTZLER
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Credential |
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Telephone | 541-296-6101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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