Provider Demographics
NPI:1790188258
Name:BRET GENE BALL LLC
Entity Type:Organization
Organization Name:BRET GENE BALL LLC
Other - Org Name:ROSE CITY SPINE SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRET
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:971-447-0700
Mailing Address - Street 1:10101 SE MAIN ST STE 2014
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2457
Mailing Address - Country:US
Mailing Address - Phone:971-447-0700
Mailing Address - Fax:971-223-0961
Practice Address - Street 1:10000 SE MAIN ST
Practice Address - Street 2:318
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2448
Practice Address - Country:US
Practice Address - Phone:503-253-4000
Practice Address - Fax:503-253-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD164558174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR172496Medicare PIN