Provider Demographics
NPI:1679696157
Name:ORTHOPEDIC HEALTHCARE ANCILLARY SERVICES, LLC
Entity type:Organization
Organization Name:ORTHOPEDIC HEALTHCARE ANCILLARY SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-485-8111
Mailing Address - Street 1:55 COBURG RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2433
Mailing Address - Country:US
Mailing Address - Phone:541-485-8111
Mailing Address - Fax:541-342-6379
Practice Address - Street 1:55 COBURG RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2433
Practice Address - Country:US
Practice Address - Phone:541-485-8111
Practice Address - Fax:541-342-6379
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SLOCUM ORTHOPEDICS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-09
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR274618Medicaid
OR274618Medicaid