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Organization
PONY CREEK ANNEX, LLC
Active
Organization
PONY CREEK ANNEX, LLC
Active
Other names
Bay Eye Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
JANE GILBERT MD (MEDICAL DIRECTOR)
(541) 297-9551
Entity
Organization
Contact information
Practice address
2075 PUBLIC SQUARE COURT, NORTH BEND, OR 97459-1270
(541) 297-9551
Mailing address
3585 BROADWAY AVE, NORTH BEND, OR 97459-1251
(541) 756-2584
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
NULL
Other
Enumeration date
06/09/2021
Last updated
06/09/2021
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