Provider Demographics
NPI:1124069620
Name:EASTERN OREGON MEDICAL ASSOCIATES,LLC
Entity type:Organization
Organization Name:EASTERN OREGON MEDICAL ASSOCIATES,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCHOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-523-1001
Mailing Address - Street 1:3950 17TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-1300
Mailing Address - Country:US
Mailing Address - Phone:541-523-1001
Mailing Address - Fax:541-523-1152
Practice Address - Street 1:3950 17TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-1300
Practice Address - Country:US
Practice Address - Phone:541-523-1001
Practice Address - Fax:541-523-1152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR276275Medicaid
OR838159000OtherBLUE CROSS #
ORDA6341OtherRAILROAD
OR117091Medicare ID - Type UnspecifiedPART B
OR383852Medicare Oscar/Certification
OR276275Medicaid