Provider Demographics
NPI:1841396405
Name:ROSEBURG CLINIC, P.C.
Entity Type:Organization
Organization Name:ROSEBURG CLINIC, P.C.
Other - Org Name:ENT ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHREINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-673-8988
Mailing Address - Street 1:2750 W HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-2608
Mailing Address - Country:US
Mailing Address - Phone:541-673-8988
Mailing Address - Fax:541-672-8103
Practice Address - Street 1:2801 NW MERCY DR
Practice Address - Street 2:STE 330
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-2348
Practice Address - Country:US
Practice Address - Phone:541-677-3300
Practice Address - Fax:541-672-8103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21871207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1164790003Medicare NSC