Provider Demographics
NPI:1649314253
Name:NEUROLOGY OF BEND LLC
Entity type:Organization
Organization Name:NEUROLOGY OF BEND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BUCHHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-388-3311
Mailing Address - Street 1:2421 NE DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6031
Mailing Address - Country:US
Mailing Address - Phone:541-388-3311
Mailing Address - Fax:541-389-1887
Practice Address - Street 1:2421 NE DOCTORS DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6031
Practice Address - Country:US
Practice Address - Phone:541-388-3311
Practice Address - Fax:541-389-1887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR213485Medicaid
ORR119443Medicare PIN