Provider Demographics
NPI:1629147343
Name:GRANTS PASS SURGICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:GRANTS PASS SURGICAL ASSOCIATES PC
Other - Org Name:GRANTS PASS SURGICAL ASSOCIATES, P.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREIVE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:541-474-5533
Mailing Address - Street 1:1600 NW 6TH STREET
Mailing Address - Street 2:NORTH SUITE
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526
Mailing Address - Country:US
Mailing Address - Phone:541-474-5533
Mailing Address - Fax:541-476-2380
Practice Address - Street 1:1600 NW 6TH STREET
Practice Address - Street 2:NORTH SUITE
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526
Practice Address - Country:US
Practice Address - Phone:541-474-5533
Practice Address - Fax:541-476-2380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0700000909208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227331Medicaid
OR227331Medicaid