Glenn M Koteen M.D., LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

MD25338 Issued in OR

Legal business name

GLENN M KOTEEN M.D., LLC

Practice address

2450 NE Mary Rose PL
Ste 210
Bend, OR 97701-7132

Phone

(541) 728-0535

Fax

(541) 647-5125

NPI assigned

Apr 22, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Glenn M Koteen, MD

Title

Owner/Physician

Phone

(541) 728-0535

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Gastroenterology of Central Oregon Doing business as

Locations

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

{
    "created_epoch": "1208822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226620800000",
    "number": "1407021348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 NE MARY ROSE PL",
            "address_2": "STE 210",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977017132",
            "telephone_number": "541-728-0535",
            "fax_number": "541-647-5125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 NE MARY ROSE PL",
            "address_2": "STE 210",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977017132",
            "telephone_number": "541-728-0535",
            "fax_number": "541-647-5125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENN M KOTEEN M.D., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-22",
        "last_updated": "2008-11-14",
        "status": "A",
        "authorized_official_last_name": "KOTEEN",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "541-728-0535",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "OR",
            "license": "MD25338",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE #",
            "identifier": "120175",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "022737",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gastroenterology of Central Oregon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Medical Specialty Clinic/Center in Bend, OR
• Providers in Bend, OR by specialty
• Medical Specialty Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2008; 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.