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
—
—
Other
Enumeration date
06/09/2021
Last updated
06/09/2021
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