Provider Demographics
NPI:1811649544
Name:THE STUDIO LA PINE
Entity type:Organization
Organization Name:THE STUDIO LA PINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:ASH
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:541-876-2100
Mailing Address - Street 1:52765 HOWARD LN
Mailing Address - Street 2:
Mailing Address - City:LA PINE
Mailing Address - State:OR
Mailing Address - Zip Code:97739-9417
Mailing Address - Country:US
Mailing Address - Phone:808-280-2087
Mailing Address - Fax:
Practice Address - Street 1:51470 HIGHWAY 97 STE 5A
Practice Address - Street 2:
Practice Address - City:LA PINE
Practice Address - State:OR
Practice Address - Zip Code:97739-9868
Practice Address - Country:US
Practice Address - Phone:541-876-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty