Provider Demographics
NPI:1275784001
Name:SYNERGY MEDICAL SYSTEMS, LLC.
Entity Type:Organization
Organization Name:SYNERGY MEDICAL SYSTEMS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:PAUL
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:SUITE 1
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-9192
Mailing Address - Country:US
Mailing Address - Phone:541-343-3758
Mailing Address - Fax:541-342-3341
Practice Address - Street 1:25589 SW CANYON CREEK RD STE 600
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-6874
Practice Address - Country:US
Practice Address - Phone:503-570-8782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR258017-96332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500628910Medicaid
OR3021091OtherBLUE CROSS