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Organization

GORGE BONE DENSITY TESTING LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CAROLANN J TATE (OFFICE MANAGER)
(509) 493-1467
Entity
Organization

Contact information

Practice address
1825 E 19TH ST, SUITE 3, THE DALLES, OR 97058-3365
(509) 493-1467
(509) 493-3765
Mailing address
1825 E 19TH ST, SUITE 3, THE DALLES, OR 97058-3365
(509) 493-1467
(509) 493-3765

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
286691
OR
01
7115249
WASHINGTON MEDICAID
WA
01
K285400
PACIFIC SOURCE
OR
Enumeration date
08/06/2006
Last updated
09/06/2007
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