Lifestyle Medicine of Central Oregon, PC

Primary specialty

Gynecology PhysicianTaxonomy code 207VG0400X

License

MD17360 Issued in OR

Legal business name

LIFESTYLE MEDICINE OF CENTRAL OREGON, PC

Practice address

497 SW Century Dr
Suite 120
Bend, OR 97702-1167

Phone

(541) 291-9960

Fax

(541) 291-9961

NPI assigned

Aug 3, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mary Huntsman, MD

Title

Owner

Phone

(541) 291-9960

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1343952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366070400000",
    "number": "1013264456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "497 SW CENTURY DR",
            "address_2": "SUITE 120",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977021167",
            "telephone_number": "541-291-9960",
            "fax_number": "541-291-9961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "497 SW CENTURY DR",
            "address_2": "SUITE 120",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977021167",
            "telephone_number": "541-291-9960",
            "fax_number": "541-291-9961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESTYLE MEDICINE OF CENTRAL OREGON, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-03",
        "last_updated": "2013-04-16",
        "status": "A",
        "authorized_official_last_name": "HUNTSMAN",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-291-9960",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "OR",
            "license": "MD17360",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Liesl Farnsworth, PHD, LPC
• Life Balance Bend LLC
• Life Dynamics LLC
• Life Works of Central Oregon, LLC
• Lifesource Therapy LLC
• Lifetime Vision Care
• Lifetime Vision Care LLC
• McKenzie L Lighty, LMT
• Matthew Raymond Lilley, MD
• Albert Jackson Lilly III, MD

• Gynecology Physician in Bend, OR
• Providers in Bend, OR by specialty
• Gynecology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.