Provider Demographics
NPI:1225421191
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:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUMGARTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-343-3758
Mailing Address - Street 1:1710 WILLOW CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-9192
Mailing Address - Country:US
Mailing Address - Phone:541-852-4010
Mailing Address - Fax:541-852-4110
Practice Address - Street 1:4050 LAKE OTIS PKWY STE 207
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:866-428-0826
Practice Address - Fax:541-343-3034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-16
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1011312332B00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1632212Medicaid
OR5365240003Medicare PIN
OR5365240002Medicare PIN