Provider Demographics
NPI:1730138777
Name:BEND OB-GYN LLC
Entity Type:Organization
Organization Name:BEND OB-GYN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PALACIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-385-8050
Mailing Address - Street 1:2450 NE MARY ROSE PL
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7132
Mailing Address - Country:US
Mailing Address - Phone:541-385-8050
Mailing Address - Fax:541-385-8589
Practice Address - Street 1:2450 NE MARY ROSE PL
Practice Address - Street 2:SUITE 220
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7132
Practice Address - Country:US
Practice Address - Phone:541-385-8050
Practice Address - Fax:541-385-8589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR286781Medicaid
ORR112541Medicare ID - Type UnspecifiedMEDICARE GROUP ID #