Provider Demographics
NPI:1598252272
Name:VENEL ORTHOPAEDIC INSTITUTE AT LAKE ANDREW
Entity Type:Organization
Organization Name:VENEL ORTHOPAEDIC INSTITUTE AT LAKE ANDREW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:RUX
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:503-784-8029
Mailing Address - Street 1:7306 N COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-1514
Mailing Address - Country:US
Mailing Address - Phone:503-784-8029
Mailing Address - Fax:
Practice Address - Street 1:10000 SE MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2448
Practice Address - Country:US
Practice Address - Phone:503-784-8029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-18
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty