Provider Demographics
NPI:1417014150
Name:BOYLE CLINICS PC
Entity Type:Organization
Organization Name:BOYLE CLINICS PC
Other - Org Name:INOVIA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-382-8346
Mailing Address - Street 1:2200 NE NEFF RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4283
Mailing Address - Country:US
Mailing Address - Phone:541-382-8346
Mailing Address - Fax:
Practice Address - Street 1:2200 NE NEFF RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4283
Practice Address - Country:US
Practice Address - Phone:541-382-8346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23277174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR287197Medicaid
ORG00430Medicare UPIN
OR287197Medicaid