Provider Demographics
NPI:1528067758
Name:SOUTH EUGENE SURGI-CENTER, LLC
Entity type:Organization
Organization Name:SOUTH EUGENE SURGI-CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:KARASEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-284-5184
Mailing Address - Street 1:675 E 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4304
Mailing Address - Country:US
Mailing Address - Phone:541-284-5184
Mailing Address - Fax:541-284-5185
Practice Address - Street 1:675 E 19TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4304
Practice Address - Country:US
Practice Address - Phone:541-284-5184
Practice Address - Fax:541-284-5185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR071530261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR109413Medicare PIN