=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922003052
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EAST OREGON SURGERY CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2005
-----------------------------------------------------
Last Update Date | 06/04/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1050 SOUTHGATE STE B
-----------------------------------------------------
City | PENDLETON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97801-3953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-276-3212
-----------------------------------------------------
Fax | 541-278-8003
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1050 SOUTHGATE STE B
-----------------------------------------------------
City | PENDLETON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97801-3953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-276-3212
-----------------------------------------------------
Fax | 541-278-8003
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | BART A ADAMS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 541-276-3212
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | 071538
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------