Provider Demographics
NPI:1689800666
Name:BSM SURGERY CENTER LLC
Entity Type:Organization
Organization Name:BSM SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:KOLB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-268-4641
Mailing Address - Street 1:1128 NE SECOND STREET
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6293
Mailing Address - Country:US
Mailing Address - Phone:541-207-3334
Mailing Address - Fax:541-207-3231
Practice Address - Street 1:1128 NE SECOND STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6293
Practice Address - Country:US
Practice Address - Phone:541-207-3334
Practice Address - Fax:541-207-3231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-04
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORPENDINGMedicaid
OR500639211Medicaid
OR38C0001096Medicare Oscar/Certification
ORR157581Medicare PIN