Provider Demographics
NPI:1083850689
Name:BEND PLASTIC & RECONSTRUCTIVE SURGERY, LLC
Entity Type:Organization
Organization Name:BEND PLASTIC & RECONSTRUCTIVE SURGERY, LLC
Other - Org Name:BEND PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:ANGELES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-749-2282
Mailing Address - Street 1:1239 NE MEDICAL CENTER DR STE 240
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7359
Mailing Address - Country:US
Mailing Address - Phone:541-749-2282
Mailing Address - Fax:541-749-2283
Practice Address - Street 1:1239 NE MEDICAL CENTER DR STE 240
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7359
Practice Address - Country:US
Practice Address - Phone:541-749-2282
Practice Address - Fax:541-749-2283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-02
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26066261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty