Pony Creek Annex, LLC
NPI #1538736459 in North Bend, Oregon
Provider Information
- NPI Number
- 1538736459
- Entity Type
- Organization
- Organization Name
- Pony Creek Annex, LLC
- Primary Specialty
- Clinic/Center - Ambulatory Surgical
- Enumeration Date
- Jun 9, 2021
- Last Updated
- Jun 9, 2021
Practice Location
- Address
- 2075 PUBLIC SQUARE COURT
- City
- North Bend
- State
- Oregon
- ZIP Code
- 97459-1270
- Phone
- (541) 297-9551
Authorized Official
- Name
- JANE GILBERT, MD
- Title
- MEDICAL DIRECTOR
- Phone
- (541) 297-9551
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Ambulatory Surgical — Ambulatory Surgical |
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