Organization
EDWARD L VAN TASSEL DO PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEANNETTE L GANSBERG (EXECUTIVE DIRECTOR)
(541) 274-2902
Entity
Organization
Contact information
Practice address
2200 BRYANT WILLIAMS DR, STE 1, KLAMATH FALLS, OR 97601-1121
(541) 884-7746
(541) 274-5705
Mailing address
2200 BRYANT WILLIAMS DR, STE 1, KLAMATH FALLS, OR 97601-1121
(541) 884-7746
(541) 274-5705
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
DO25890
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
213618
—
OR
01
—
820591000
BLUE CROSS
OR
01
—
DG1609
RAIL ROAD MEDICARE
OR
01
—
XPY145960
MEDICAL
CA
Enumeration date
04/26/2007
Last updated
03/07/2023
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