Organization
BEND DERMATOLOGY CLINIC LLC
Active
Parent organization
BEND DERMATOLOGY CLINIC LLC
Other names
Cascadia Histopathology
Organization subpart
Yes
Provider details
NPI number
Legal business name
BEND DERMATOLOGY CLINIC LLC
Authorized official
MRS. SUZANNE R MAITLAND (ADMINISTRATOR)
(541) 322-1980
Entity
Organization
Contact information
Practice address
2705 NE CONNERS AVE, BEND, OR 97701-6904
(541) 382-5712
(541) 382-2605
Mailing address
2747 NE CONNERS AVE, BEND, OR 97701-8738
(541) 382-5712
(541) 382-2605
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
38D0628271
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00692242
RAIL ROAD MEDICARE PTAN
OR
Enumeration date
10/14/2008
Last updated
05/16/2012
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