MEDICARE: CENTERSOURCE CORPORATION

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	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1467881706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTERSOURCE CORPORATION

Provider Business Mailing Address
First Line	:	2988 NW FAIRWAY HEIGHTS DR
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-8334
Country	:	US
Telephone Number	:	877-293-1472
Fax Number	:	877-293-1475

Provider Business Practice Location Address
First Line	:	2988 NW FAIRWAY HEIGHTS DR
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-8334
Country	:	US
Telephone Number	:	877-293-1472
Fax Number	:	877-293-1475

Authorized Official
Title or Position	:	FOUNDER
Name	:	KEVIN HOFFMAN
Credential	:
Telephone Number	:	877-293-1472

Provider Enumeration Date	:	11/07/2013
Last Update Date	:	02/07/2017

Similar Medicare Providers

1659115228 — HEATHER CLAFFEY FNP-C
Practice Location Address:

2175 NW SHEVLIN PARK RD
BEND, OR
97703-7101

Practice Phone: 541-389-7741
Practice Fax: 541-278-8375

1952663387 — MS. AMY DINEEN LMFT
Practice Location Address:

62930 O B RILEY RD STE 200
BEND, OR
97703-9459

Practice Phone: 541-330-1919
Practice Fax: 541-868-2003

1922625904 — JILLIAN MARCUCCI M.A.
Practice Location Address:

63311 JAMISON ST
BEND, OR
97703-8288

Practice Phone: 541-322-7500
Practice Fax: 541-322-7565

1144185414 — DEANNA KAY
Practice Location Address:

1236 NW BALTIMORE AVE
BEND, OR
97703-3125

Practice Phone: 530-448-7207
Practice Fax:

1063014538 — ERICA RAE WIMBISH
Practice Location Address:

63311 JAMISON ST
BEND, OR
97703-8288

Practice Phone: 541-322-7500
Practice Fax: 541-322-7565

1881480408 — JESSICA RAE LCSW
Practice Location Address:

2955 N HWY 97
BEND, OR
97703-7559

Practice Phone: 541-203-0474
Practice Fax: 541-610-1692

Directions to “CENTERSOURCE CORPORATION ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.