Provider Demographics
NPI:1053595603
Name:NORTHEAST OREGON SURGICAL CLINIC
Entity type:Organization
Organization Name:NORTHEAST OREGON SURGICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL SURGEON
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOWER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-966-1001
Mailing Address - Street 1:2474 S. W. PERKINS AVE
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801
Mailing Address - Country:US
Mailing Address - Phone:541-966-1001
Mailing Address - Fax:541-966-1195
Practice Address - Street 1:2474 S.W. PERKINS AVE
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801
Practice Address - Country:US
Practice Address - Phone:541-966-1001
Practice Address - Fax:541-966-1195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26075208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty