Provider Demographics
NPI:1922003052
Name:EAST OREGON SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:EAST OREGON SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BART
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-276-3212
Mailing Address - Street 1:1050 SOUTHGATE
Mailing Address - Street 2:STE B
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-3953
Mailing Address - Country:US
Mailing Address - Phone:541-276-3212
Mailing Address - Fax:541-278-8003
Practice Address - Street 1:1050 SOUTHGATE
Practice Address - Street 2:STE B
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-3953
Practice Address - Country:US
Practice Address - Phone:541-276-3212
Practice Address - Fax:541-278-8003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR071538261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR114033Medicaid
ORR134244Medicare PIN