Provider Demographics
NPI:1386070464
Name:ROBERT W GEISTER AND ASSOCIATES INC
Entity type:Organization
Organization Name:ROBERT W GEISTER AND ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:GEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:503-475-5018
Mailing Address - Street 1:17187 HOOD CT
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-6498
Mailing Address - Country:US
Mailing Address - Phone:503-475-5018
Mailing Address - Fax:503-668-8310
Practice Address - Street 1:39400 PIONEER BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-8000
Practice Address - Country:US
Practice Address - Phone:503-668-5210
Practice Address - Fax:503-668-8310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00041261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORT67637Medicare UPIN
ORR0000SGBCBMedicare PIN