Provider Demographics
NPI:1811920366
Name:MIDDLE FORK SURGERY CENTER LLC
Entity type:Organization
Organization Name:MIDDLE FORK SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GESSELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-334-0488
Mailing Address - Street 1:360 S GARDEN WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-8173
Mailing Address - Country:US
Mailing Address - Phone:541-334-0488
Mailing Address - Fax:
Practice Address - Street 1:360 S GARDEN WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8173
Practice Address - Country:US
Practice Address - Phone:541-334-0488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAIN CONSULTANTS OF OREGON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-08
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain