Provider Demographics
NPI:1184782203
Name:EASTERN OREGON REGIONAL SURGERY
Entity type:Organization
Organization Name:EASTERN OREGON REGIONAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-567-6330
Mailing Address - Street 1:1070 W ELM AVE STE B
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-2711
Mailing Address - Country:US
Mailing Address - Phone:541-289-8900
Mailing Address - Fax:458-219-2640
Practice Address - Street 1:1070 W ELM AVE STE B
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-2711
Practice Address - Country:US
Practice Address - Phone:541-289-8900
Practice Address - Fax:458-219-2640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2023-08-28
Deactivation Date:2023-06-29
Deactivation Code:
Reactivation Date:2023-08-28
Provider Licenses
StateLicense IDTaxonomies
OR394721261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR232855Medicaid
ORP256501OtherPACIFICSOURCE
ORP00053720OtherRAILROAD MEDICARE
OR232855Medicaid
OR232855Medicaid