Provider Demographics
NPI:1376848002
Name:COLUMBIA RIVER ANESTHESIA, LLC
Entity Type:Organization
Organization Name:COLUMBIA RIVER ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:DUDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, CRNA
Authorized Official - Phone:307-251-0502
Mailing Address - Street 1:1122 W ELM AVE
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-6933
Mailing Address - Country:US
Mailing Address - Phone:307-251-0502
Mailing Address - Fax:
Practice Address - Street 1:1122 W ELM AVE
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-6933
Practice Address - Country:US
Practice Address - Phone:307-251-0502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR090007538CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty