Provider Demographics
NPI:1376504316
Name:THE WOMEN'S CENTER OF CENTRAL OREGON
Entity Type:Organization
Organization Name:THE WOMEN'S CENTER OF CENTRAL OREGON
Other - Org Name:DR. SUSAN M. GORMAN
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-923-5879
Mailing Address - Street 1:1001 NW CANAL BLVD
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-1420
Mailing Address - Country:US
Mailing Address - Phone:541-504-7635
Mailing Address - Fax:541-923-5902
Practice Address - Street 1:1001 NW CANAL BLVD
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1420
Practice Address - Country:US
Practice Address - Phone:541-504-7635
Practice Address - Fax:541-923-5902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22835174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR288033Medicaid
ORR130898Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
ORMD22835Medicare UPIN