Provider Demographics
NPI:1063026466
Name:KYLE D. HOMERTGEN
Entity Type:Organization
Organization Name:KYLE D. HOMERTGEN
Other - Org Name:BEND OSTEOPATHIC CARE PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ATTLEBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-573-8312
Mailing Address - Street 1:147 SW SHEVLIN HIXON DR STE 204
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1137
Mailing Address - Country:US
Mailing Address - Phone:541-706-9985
Mailing Address - Fax:
Practice Address - Street 1:147 SW SHEVLIN HIXON DR STE 204
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1137
Practice Address - Country:US
Practice Address - Phone:541-706-9985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty