Provider Demographics
NPI:1811919913
Name:KLAMATH ORTHOPEDIC CLINIC PC
Entity type:Organization
Organization Name:KLAMATH ORTHOPEDIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GANSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-274-2902
Mailing Address - Street 1:2200 BRYANT WILLIAMS DRIVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OREGON
Mailing Address - Zip Code:97601-1121
Mailing Address - Country:UM
Mailing Address - Phone:541-884-7746
Mailing Address - Fax:541-274-5705
Practice Address - Street 1:2200 BRYANT WILLIAMS DR
Practice Address - Street 2:SUITE 1
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1120
Practice Address - Country:US
Practice Address - Phone:541-884-7746
Practice Address - Fax:541-274-5705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR200010673OtherRAILROAD MEDICARE
OR200044954OtherRAILROAD MEDICARE
ORCO3632OtherRAIL ROAD MEDICARE
ORP01815487OtherRAIL ROAD MEDICARE
ORP01702513OtherRAILROAD MEDICARE
OR002635000OtherBLUE CROSS
OR500679872Medicaid
ORP01432107OtherRAILROAD MEDICARE
OR284783Medicaid
OR261198Medicaid
OR284783Medicaid
OR500721344Medicaid
ORP01432107OtherRAILROAD MEDICARE
OR002635000OtherBLUE CROSS
OR200044954OtherRAILROAD MEDICARE
ORR130642Medicare PIN
OR200044954OtherRAILROAD MEDICARE
OR274622Medicaid
ORR138719Medicare PIN
OR261198Medicaid
OR040592Medicaid
ORP01432107OtherRAILROAD MEDICARE
ORR131950Medicare PIN
ORR178621Medicare PIN
ORR105161Medicare PIN