Provider Demographics
NPI:1639614951
Name:INVMD PLASTIC SURGERY LLC
Entity Type:Organization
Organization Name:INVMD PLASTIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:NICOLAS
Authorized Official - Last Name:VIAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-317-0808
Mailing Address - Street 1:2450 NE MARY ROSE PL
Mailing Address - Street 2:STE 201
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701
Mailing Address - Country:US
Mailing Address - Phone:541-317-0808
Mailing Address - Fax:541-317-3585
Practice Address - Street 1:2450 NE MARY ROSE PL
Practice Address - Street 2:STE 200
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7132
Practice Address - Country:US
Practice Address - Phone:541-317-0808
Practice Address - Fax:541-317-3585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-21
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500719361Medicaid