Provider Demographics
NPI:1164464616
Name:GASTROENTEROLOGY SPECIALISTS OF OREGON PC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY SPECIALISTS OF OREGON PC
Other - Org Name:CLACKAMAS GASTROENTEROLOGY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:G
Authorized Official - Last Name:TAUSCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-224-2457
Mailing Address - Street 1:1508 DIVISION ST
Mailing Address - Street 2:SUITE 15
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-1583
Mailing Address - Country:US
Mailing Address - Phone:503-657-5555
Mailing Address - Fax:503-657-6502
Practice Address - Street 1:1508 DIVISION ST
Practice Address - Street 2:SUITE 15
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1583
Practice Address - Country:US
Practice Address - Phone:503-657-5555
Practice Address - Fax:503-657-6502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR171447Medicaid
0000WCGSMMedicare ID - Type Unspecified