Provider Demographics
NPI:1508873779
Name:VINOD K VINJAMURI MD LLC
Entity Type:Organization
Organization Name:VINOD K VINJAMURI MD LLC
Other - Org Name:GLENEDEN BEACH MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VINOD
Authorized Official - Middle Name:K
Authorized Official - Last Name:VINJAMURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-764-3360
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:GLENEDEN BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97388-0279
Mailing Address - Country:US
Mailing Address - Phone:541-764-3360
Mailing Address - Fax:541-764-3362
Practice Address - Street 1:6615 GLENEDEN BEACH LOOP
Practice Address - Street 2:
Practice Address - City:GLENEDEN BEACH
Practice Address - State:OR
Practice Address - Zip Code:97388
Practice Address - Country:US
Practice Address - Phone:541-764-3360
Practice Address - Fax:541-764-3362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18179207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR051867Medicaid
ORF10866Medicare UPIN
OR115452Medicare PIN
OR115452Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER