Provider Demographics
NPI:1740654086
Name:DESCHUTES FAMILY CARE, LLC
Entity type:Organization
Organization Name:DESCHUTES FAMILY CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GONSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:541-323-3960
Mailing Address - Street 1:1345 NW WALL ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-1972
Mailing Address - Country:US
Mailing Address - Phone:541-323-3960
Mailing Address - Fax:541-323-3961
Practice Address - Street 1:1345 NW WALL ST
Practice Address - Street 2:SUITE 302
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-1972
Practice Address - Country:US
Practice Address - Phone:541-323-3960
Practice Address - Fax:541-323-3961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-24
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO 155003261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care