Provider Demographics
NPI:1184884959
Name:SANTIAM GASTROENTEROLOGY PC
Entity type:Organization
Organization Name:SANTIAM GASTROENTEROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GASTROENTEROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:ERIKA
Authorized Official - Last Name:CSANKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-926-6030
Mailing Address - Street 1:3065 NW HURLEYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-9641
Mailing Address - Country:US
Mailing Address - Phone:541-917-1959
Mailing Address - Fax:
Practice Address - Street 1:1086 7TH AVE SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-1997
Practice Address - Country:US
Practice Address - Phone:541-926-6030
Practice Address - Fax:541-928-2942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-14
Last Update Date:2008-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26092261QE0800X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy