Provider Demographics
NPI:1811242308
Name:MACIEY J DRUZDZEL MD PC
Entity type:Organization
Organization Name:MACIEY J DRUZDZEL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MACIEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DRUZDZEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1541-247-9499
Mailing Address - Street 1:PO BOX 1650
Mailing Address - Street 2:29593 ELLENSBURG
Mailing Address - City:GOLD BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97444-1650
Mailing Address - Country:US
Mailing Address - Phone:154-124-7949
Mailing Address - Fax:154-124-7967
Practice Address - Street 1:29593 ELLENSBURG AVE.
Practice Address - Street 2:
Practice Address - City:GOLD BEACH
Practice Address - State:OR
Practice Address - Zip Code:97444-1650
Practice Address - Country:US
Practice Address - Phone:154-124-7949
Practice Address - Fax:154-124-7967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18563261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR121280Medicaid
ORR104978OtherMEDICARE
OR121280Medicaid