Provider Demographics
NPI:1700301447
Name:LUMOS MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:LUMOS MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:REN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDASBAD
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LAC
Authorized Official - Phone:541-728-3790
Mailing Address - Street 1:20472 DEL COCO CT
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-9414
Mailing Address - Country:US
Mailing Address - Phone:712-330-5106
Mailing Address - Fax:
Practice Address - Street 1:335 NE REVERE AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701
Practice Address - Country:US
Practice Address - Phone:541-728-3790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4040261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care