MEDICARE: KLAMATH ORTHOPEDIC CLINIC PC

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	174400000X	Specialist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200010673	OTHER	OR	RAILROAD MEDICARE
2	200044954	OTHER	OR	RAILROAD MEDICARE
3	CO3632	OTHER	OR	RAIL ROAD MEDICARE
4	P01815487	OTHER	OR	RAIL ROAD MEDICARE
5	P01702513	OTHER	OR	RAILROAD MEDICARE
8	P01432107	OTHER	OR	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	002635000	OTHER	OR	BLUE CROSS
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811919913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KLAMATH ORTHOPEDIC CLINIC PC

Provider Business Mailing Address
First Line	:	2200 BRYANT WILLIAMS DRIVE
Second Line	:	SUITE 1
City	:	KLAMATH FALLS
State	:	OREGON
Zip	:	97601-1121
Country	:	UM
Telephone Number	:	541-884-7746
Fax Number	:	541-274-5705

Provider Business Practice Location Address
First Line	:	2200 BRYANT WILLIAMS DR
Second Line	:	SUITE 1
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-1120
Country	:	US
Telephone Number	:	541-884-7746
Fax Number	:	541-274-5705

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JEANNETTE GANSBERG
Credential	:
Telephone Number	:	541-274-2902

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	06/19/2024

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Directions to “KLAMATH ORTHOPEDIC CLINIC PC ” Practice Location

Language	Start Address	Practice Location

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