Provider Demographics
NPI:1154093847
Name:BA VENTURES LLC
Entity Type:Organization
Organization Name:BA VENTURES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BALA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMBATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-343-5000
Mailing Address - Street 1:2435 NW KLINE ST
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-1687
Mailing Address - Country:US
Mailing Address - Phone:541-343-5000
Mailing Address - Fax:
Practice Address - Street 1:2435 NW KLINE ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1687
Practice Address - Country:US
Practice Address - Phone:541-673-8182
Practice Address - Fax:541-673-9083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-30
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty