Columbia Gorge Anesthesia LLC

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

200860006CRNA Issued in OR

Legal business name

COLUMBIA GORGE ANESTHESIA LLC

Practice address

1020 Webber St
The Dalles, OR 97058-3749

Phone

(541) 769-0426

Fax

(541) 769-0431

NPI assigned

May 30, 2013

Organization subpart

No

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

Authorized official

Name

Mr. David C Bullock, CRNA

Title

President

Phone

(714) 347-1010

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1369872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1393891200000",
    "number": "1669819652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 N TUSTIN AVE",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927053807",
            "telephone_number": "714-347-1010",
            "fax_number": "714-647-1245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 WEBBER ST",
            "city": "THE DALLES",
            "state": "OR",
            "postal_code": "970583749",
            "telephone_number": "541-769-0426",
            "fax_number": "541-769-0431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBIA GORGE ANESTHESIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-30",
        "last_updated": "2014-03-04",
        "status": "A",
        "authorized_official_last_name": "BULLOCK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-347-1010",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OR",
            "license": "200860006CRNA",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Clemence, QMHP
• Cassandra Cleveland
• David J Cleveland, MD
• Marcella Clough
• Netta Lynn Cochran
• Columbia Gorge Education Service District
• Columbia Gorge Education Service District
• Columbia Gorge ENT, LLC
• Columbia Gorge Hearing Care LLC
• Columbia Gorge Neurology Specialists, LLC

• Certified Registered Nurse Anesthetist in The Dalles, OR
• Providers in The Dalles, OR by specialty
• Certified Registered Nurse Anesthetist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2014; 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.