Provider Demographics
NPI:1184439820
Name:CENTRAL OREGON INTERNAL MEDICINE LLC
Entity type:Organization
Organization Name:CENTRAL OREGON INTERNAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JAN
Authorized Official - Last Name:INGRASSIA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:541-728-2114
Mailing Address - Street 1:2275 NE DOCTORS DR STE 7
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6324
Mailing Address - Country:US
Mailing Address - Phone:541-728-2114
Mailing Address - Fax:541-749-2126
Practice Address - Street 1:2275 NE DOCTORS DR STE 7
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6324
Practice Address - Country:US
Practice Address - Phone:541-728-2114
Practice Address - Fax:541-749-2126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-10
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty