Provider Demographics
NPI:1417005455
Name:GORGE BONE DENSITY TESTING
Entity Type:Organization
Organization Name:GORGE BONE DENSITY TESTING
Other - Org Name:FRAN M YUHAS
Other - Org Type:Other Name
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:NICHOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-493-1467
Mailing Address - Street 1:1825 E 19TH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-3365
Mailing Address - Country:US
Mailing Address - Phone:509-493-1467
Mailing Address - Fax:509-493-3765
Practice Address - Street 1:1825 E 19TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3365
Practice Address - Country:US
Practice Address - Phone:509-493-1467
Practice Address - Fax:509-493-3765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17839207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORK285402OtherPACIFIC SOURCE
OR064659Medicaid
WA1088970OtherWASHINGTON MEDICAID
WA1088970OtherWASHINGTON MEDICAID
ORF54251Medicare UPIN