Provider Demographics
NPI:1356553242
Name:THREE SISTERS COSMETIC SURGERY LLC
Entity type:Organization
Organization Name:THREE SISTERS COSMETIC SURGERY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:LINDSAY
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:541-388-3006
Mailing Address - Street 1:1715 SW CHANDLER AVENUE
Mailing Address - Street 2:STE 100
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3200
Mailing Address - Country:US
Mailing Address - Phone:541-388-3006
Mailing Address - Fax:541-382-7605
Practice Address - Street 1:1715 SW CHANDLER AVE
Practice Address - Street 2:STE 100
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3200
Practice Address - Country:US
Practice Address - Phone:541-388-3006
Practice Address - Fax:541-382-7605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD184442086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1346225851OtherRICHARD E LINDSAY PA-C
OR1871577643OtherDR LINDA J LEFFEL M.D.
OR240342Medicaid
OR1346225851OtherRICHARD E LINDSAY PA-C
ORR140594Medicare PIN