Provider Demographics
NPI:1528015039
Name:NORTHSTAR NEUROLOGY LLC
Entity Type:Organization
Organization Name:NORTHSTAR NEUROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-330-6463
Mailing Address - Street 1:2275 NE DOCTORS DR
Mailing Address - Street 2:STE 9
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6324
Mailing Address - Country:US
Mailing Address - Phone:541-330-6463
Mailing Address - Fax:541-330-1490
Practice Address - Street 1:2275 NE DOCTORS DR
Practice Address - Street 2:STE 9
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6324
Practice Address - Country:US
Practice Address - Phone:541-330-6463
Practice Address - Fax:541-330-1490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty