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General NPI Number Information
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NPI Number | 1467060293
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Entity Type | Organization
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Legal Business Name | OMSCOR LLC
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Dates
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Enumeration Date | 07/17/2020
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Last Update Date | 07/17/2020
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Provider Practice Location Address
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Address Line | 3162 STATE ST
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City | MEDFORD
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State | OR
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Zip | 97504-8450
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Country | US
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Telephone | 541-779-7799
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Fax | 541-779-7805
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Provider Business Mailing Address
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Address Line | 3162 STATE ST
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City | MEDFORD
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State | OR
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Zip | 97504-8450
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Country | US
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Telephone | 541-779-7799
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Fax | 541-779-7805
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Authorized Official
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Title or Position | INSURANCE MANAGER
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Name | LYNDA STALLINGS
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Credential |
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Telephone | 541-842-7053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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