1649222183 NPI number — DR. KARL MAGSARILI M.D.

Table of content: DR. KARL MAGSARILI M.D. (NPI 1649222183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649222183 NPI number — DR. KARL MAGSARILI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAGSARILI
Provider First Name:
KARL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649222183
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 670
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97709-0670
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-656-5273
Provider Business Mailing Address Fax Number:
503-650-4828

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 MOLALLA AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OREGON CITY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97045-3753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-656-5273
Provider Business Practice Location Address Fax Number:
503-650-4828
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD21192 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 911768081 . This is a "HEALTHNET" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 3004113-15 . This is a "BLUE CROSS HMO" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 5966733 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 151106 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 911768081 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 069013011 . This is a "BLUE CROSS/BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 911768081 . This is a "ODS" identifier . This identifiers is of the category "OTHER".




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