Provider Demographics
NPI:1396851754
Name:SYNERGY MEDICAL SYSTEMS, INC.
Entity Type:Organization
Organization Name:SYNERGY MEDICAL SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUMGARTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-343-3758
Mailing Address - Street 1:PO BOX 981
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-0045
Mailing Address - Country:US
Mailing Address - Phone:541-997-4134
Mailing Address - Fax:541-997-1706
Practice Address - Street 1:1245 RHODODENDRON DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439-0045
Practice Address - Country:US
Practice Address - Phone:541-997-4134
Practice Address - Fax:541-997-1706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1238382335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5365240001Medicare ID - Type Unspecified