MEDICARE: EDWARD L VAN TASSEL DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	DO25890	OR
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	DO25890	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00464722	OTHER	OR	RAIL ROAD MEDICARE
4	P00419803	OTHER	OR	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	XPY145960	OTHER	CA	MEDI-CAL
5	20889454297601	OTHER	OR	TRICARE
6	820591000	OTHER	OR	BLUE CROSS

General Provider Information

NPI Number	:	1093737199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD L VAN TASSEL DO

Provider Business Mailing Address
First Line	:	2200 BRYANT WILLIAMS DRIVE
Second Line	:	SUITE 1
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-1120
Country	:	US
Telephone Number	:	541-884-7746
Fax Number	:	541-884-0848

Provider Business Practice Location Address
First Line	:	2200 BRYANT WILLIAMS DRIVE
Second Line	:	SUITE 1
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-1120
Country	:	US
Telephone Number	:	541-884-7746
Fax Number	:	541-884-0848

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	03/07/2023

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Directions to “ EDWARD L VAN TASSEL DO” Practice Location

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