# CENTRAL OREGON CLINICAL GENETICS CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740572221
- **Authorized official:** DR. OSVALDO ANTONIO SCHIRRIPA M.D. (DIRECTOR/OWNER)
- **Authorized official phone:** (541) 749-8196

## Contact information

- **Practice address:** 143 SW SHEVLIN HIXON DR, SUITE \#203, BEND, OR 97702-3189
- **Practice address phone:** (541) 749-8196
- **Practice address fax:** (541) 678-5466
- **Mailing address:** 143 SW SHEVLIN HIXON DR, SUITE \#203, BEND, OR 97702-3189
- **Mailing address phone:** (541) 749-8196
- **Mailing address fax:** (541) 678-5466

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QH0100X | Health Service Clinic/Center | MD153157 | OR | — |
| 261QM2500X | Medical Specialty Clinic/Center | MD153157 | OR | Yes |
| 291U00000X | Clinical Medical Laboratory | A46201 | CA | — |

## Other

- **Enumeration date:** 05/03/2011
- **Last updated:** 03/14/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 500637246 | — | OR |
| 05 | — | 500637292 | — | OR |