Provider Demographics
NPI:1548319379
Name:UMPQUA ORTHOPEDICS PC
Entity type:Organization
Organization Name:UMPQUA ORTHOPEDICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRNACIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:541-677-2131
Mailing Address - Street 1:277 NW MEDICAL LOOP
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-1644
Mailing Address - Country:US
Mailing Address - Phone:541-677-2131
Mailing Address - Fax:547-677-2136
Practice Address - Street 1:277 NW MEDICAL LOOP
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1644
Practice Address - Country:US
Practice Address - Phone:541-677-2131
Practice Address - Fax:547-677-2136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR136725Medicare UPIN
ORR136725Medicare PIN