Provider Demographics
NPI:1346633294
Name:DESCHUTES ORTHOPEDICS, LLC
Entity Type:Organization
Organization Name:DESCHUTES ORTHOPEDICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SINGLE MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:SKRZYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-639-7800
Mailing Address - Street 1:1693 SW CHANDLER AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3236
Mailing Address - Country:US
Mailing Address - Phone:541-388-0673
Mailing Address - Fax:541-388-2619
Practice Address - Street 1:1693 SW CHANDLER AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3236
Practice Address - Country:US
Practice Address - Phone:541-388-0673
Practice Address - Fax:541-388-2619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19014207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
R176803OtherMEDICARE PTAN
OR1538272869OtherINDIVIDUAL NPI FOR DR MARY SKRZYNSKI