Provider Demographics
NPI:1013100544
Name:BOBEK ENTERPRISES PC
Entity Type:Organization
Organization Name:BOBEK ENTERPRISES PC
Other - Org Name:ANGEL MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:BOBEK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:503-325-5411
Mailing Address - Street 1:515 15TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-3812
Mailing Address - Country:US
Mailing Address - Phone:503-325-5411
Mailing Address - Fax:503-325-3711
Practice Address - Street 1:515 15TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3812
Practice Address - Country:US
Practice Address - Phone:503-325-5411
Practice Address - Fax:503-325-3711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO16469261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR009204Medicaid
OR009204Medicaid
R103179Medicare PIN