ASC Gi Diagnostic Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

071580 Issued in OR

Legal business name

ASC GI DIAGNOSTIC CENTER, LLC

Practice address

2084 NE Professional CT
Bend, OR 97701-6077

Phone

(541) 322-5753

Fax

(541) 749-2130

NPI assigned

Jun 30, 2006

Last updated

May 24, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Stephen B. Archer, MD

Title

Medical Director

Phone

(541) 322-5753

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306195200000",
    "number": "1174551758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2084 NE PROFESSIONAL CT",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016077",
            "telephone_number": "541-322-5753",
            "fax_number": "541-749-2130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2084 NE PROFESSIONAL CT",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016077",
            "telephone_number": "541-322-5753",
            "fax_number": "541-749-2130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASC GI DIAGNOSTIC CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-30",
        "last_updated": "2011-05-24",
        "status": "A",
        "authorized_official_last_name": "ARCHER",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "541-322-5753",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "OR",
            "license": "071580",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006075",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Bend, OR
• Providers in Bend, OR by specialty
• Ambulatory Surgical Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2011; 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.