Provider Demographics
NPI:1962732131
Name:BEAR CREEK SURGERY PA PC
Entity type:Organization
Organization Name:BEAR CREEK SURGERY PA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERT
Authorized Official - Middle Name:MONTE
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-488-4464
Mailing Address - Street 1:1801 HIGHWAY 99 N
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-9152
Mailing Address - Country:US
Mailing Address - Phone:541-488-4464
Mailing Address - Fax:541-512-1689
Practice Address - Street 1:2200 BRYANT WILLIAMS DR STE 1
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1121
Practice Address - Country:US
Practice Address - Phone:541-488-4464
Practice Address - Fax:541-512-1689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR028245Medicaid