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General NPI Number Information
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NPI Number | 1366449910
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Entity Type | Organization
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Legal Business Name | OREGON ENDOSCOPY CENTER, LLC
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Dates
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Enumeration Date | 06/28/2005
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Last Update Date | 07/06/2015
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Provider Practice Location Address
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Address Line | 3355 RIVERBEND DR SUITE 510
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City | SPRINGFIELD
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State | OR
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Zip | 97477-8800
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Country | US
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Telephone | 541-868-9555
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Fax | 541-868-9556
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Provider Business Mailing Address
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Address Line | 3355 RIVERBEND DR SUITE 510
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City | SPRINGFIELD
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State | OR
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Zip | 97477-8800
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Country | US
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Telephone | 541-868-9555
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Fax | 541-868-9556
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/PHYSICIAN PARTNER
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Name | DR. JONATHAN GONENNE
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Credential | MD
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Telephone | 541-868-9555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 071536
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License Number State | OR
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