Provider Demographics
NPI:1598478109
Name:K & L OMS LLC
Entity Type:Organization
Organization Name:K & L OMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRITY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-884-4000
Mailing Address - Street 1:1475 SW CHANDLER AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3239
Mailing Address - Country:US
Mailing Address - Phone:541-617-3993
Mailing Address - Fax:
Practice Address - Street 1:834 SW 11TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2633
Practice Address - Country:US
Practice Address - Phone:541-617-3993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery