Provider Demographics
NPI:1225306889
Name:SYNERGY MEDICAL SYSTEMS, LLC
Entity Type:Organization
Organization Name:SYNERGY MEDICAL SYSTEMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-343-3758
Mailing Address - Street 1:2650 SUZANNE WAY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-7319
Mailing Address - Country:US
Mailing Address - Phone:541-343-3758
Mailing Address - Fax:541-465-1165
Practice Address - Street 1:2650 SUZANNE WAY
Practice Address - Street 2:SUITE 130
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-7319
Practice Address - Country:US
Practice Address - Phone:541-343-3758
Practice Address - Fax:541-465-1165
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SYNERGY MEDICAL SYSTEMS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-09
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25801796293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory