Provider Demographics
NPI:1629240361
Name:ROBERT J. BERECZ, M.D., F.A.C.S., P.C.
Entity Type:Organization
Organization Name:ROBERT J. BERECZ, M.D., F.A.C.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-289-6575
Mailing Address - Street 1:600 NW 11TH ST
Mailing Address - Street 2:SUITE 33
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-8605
Mailing Address - Country:US
Mailing Address - Phone:541-289-6575
Mailing Address - Fax:541-289-6577
Practice Address - Street 1:600 NW 11TH ST
Practice Address - Street 2:SUITE 33
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-8605
Practice Address - Country:US
Practice Address - Phone:541-289-6575
Practice Address - Fax:541-289-6577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD09067208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR110569Medicaid
MD09067OtherOREGON LICENSE
OR053182000OtherBLUE CROSS BLUE SHIELD
OR110569Medicaid