Provider Demographics
NPI:1841475589
Name:BEND BIRTH CENTER LLC
Entity type:Organization
Organization Name:BEND BIRTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANETTE
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:GYESKY
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:541-480-1401
Mailing Address - Street 1:375 NE FRANKLIN AVE
Mailing Address - Street 2:STE. G
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4917
Mailing Address - Country:US
Mailing Address - Phone:541-480-1401
Mailing Address - Fax:541-749-2108
Practice Address - Street 1:375 NE FRANKLIN AVE
Practice Address - Street 2:STE. G
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4917
Practice Address - Country:US
Practice Address - Phone:541-480-1401
Practice Address - Fax:541-749-2108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR07-1589261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing