Provider Demographics
NPI:1518258847
Name:ELIZABETH INSTITUTE, LLC
Entity Type:Organization
Organization Name:ELIZABETH INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGO
Authorized Official - Middle Name:S
Authorized Official - Last Name:HERRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-708-5433
Mailing Address - Street 1:638 N MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1887
Mailing Address - Country:US
Mailing Address - Phone:541-708-5433
Mailing Address - Fax:541-708-5434
Practice Address - Street 1:638 N MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1887
Practice Address - Country:US
Practice Address - Phone:541-708-5433
Practice Address - Fax:541-708-5434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD153865208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500636211Medicaid