Organization
OREGON ENDOSCOPY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN GONENNE MD (MEDICAL DIRECTOR/PHYSICIAN PARTNER)
(541) 868-9555
Entity
Organization
Contact information
Practice address
3355 RIVERBEND DR, SUITE 510, SPRINGFIELD, OR 97477-8800
(541) 868-9555
(541) 868-9556
Mailing address
3355 RIVERBEND DR, SUITE 510, SPRINGFIELD, OR 97477-8800
(541) 868-9555
(541) 868-9556
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
071536
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000186
—
OR
Enumeration date
06/28/2005
Last updated
07/06/2015
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