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General NPI Number Information
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NPI Number | 1689800666
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Entity Type | Organization
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Legal Business Name | BSM SURGERY CENTER LLC
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Dates
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Enumeration Date | 06/04/2009
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Last Update Date | 09/18/2015
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Provider Practice Location Address
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Address Line | 1128 NE SECOND STREET SUITE 104
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City | CORVALLIS
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State | OR
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Zip | 97330-6293
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Country | US
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Telephone | 541-207-3334
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Fax | 541-207-3231
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Provider Business Mailing Address
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Address Line | 1128 NE SECOND STREET SUITE 104
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City | CORVALLIS
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State | OR
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Zip | 97330-6293
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Country | US
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Telephone | 541-207-3334
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Fax | 541-207-3231
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Authorized Official
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Title or Position | MANAGER
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Name | JENNIFER DAWN KOLB
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Credential |
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Telephone | 541-268-4641
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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 |
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License Number State |
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