Provider Demographics
NPI:1235371162
Name:ADVANCED ORTHOPEDIC & SPORTS MEDICINE INSTITUTE, LLC
Entity Type:Organization
Organization Name:ADVANCED ORTHOPEDIC & SPORTS MEDICINE INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:J.M.
Authorized Official - Middle Name:JEREMY
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:541-289-7075
Mailing Address - Street 1:620 NW 11TH ST
Mailing Address - Street 2:STE 201
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-8605
Mailing Address - Country:US
Mailing Address - Phone:541-289-7075
Mailing Address - Fax:541-289-1189
Practice Address - Street 1:620 NW 11TH ST
Practice Address - Street 2:STE 201
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-8605
Practice Address - Country:US
Practice Address - Phone:541-289-7075
Practice Address - Fax:541-289-1189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-24
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center