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General NPI Number Information
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NPI Number | 1821028689
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Entity Type | Organization
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Legal Business Name | ONTARIO PATHOLOGY GROUP, LLP
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 08/26/2007
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Provider Practice Location Address
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Address Line | 351 S.W. NINTH ST.
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City | ONTARIO
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State | OR
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Zip | 97914
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Country | US
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Telephone | 541-881-5331
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9589
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City | BOISE
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State | ID
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Zip | 83707-4589
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Country | US
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Telephone | 208-472-8120
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Fax | 208-344-1926
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Authorized Official
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Title or Position | PARTNER
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Name | ERIC RYSENGA
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Credential | M.D.
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Telephone | 541-881-5331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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