Basic Information
| Provider Information | |||||||||
| NPI: | 1720216963 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ONGOLE | ||||||||
| FirstName: | BHASKAR | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 WOODLAND DR | ||||||||
| Address2: | |||||||||
| City: | COOS BAY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974202045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412675151 | ||||||||
| FaxNumber: | 5412664501 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 WOODLAND DR | ||||||||
| Address2: | |||||||||
| City: | COOS BAY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974202045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412675151 | ||||||||
| FaxNumber: | 5412664501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2009 | ||||||||
| LastUpdateDate: | 01/27/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 240789 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD158190 | OR | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | R0000WFBTV | 01 | OR | GROUP MEDICARE NORTH BEND MEDICAL CENTER | OTHER | 500664151 | 05 | OR | MEDICAID | 93-0635514 | 01 | OR | GROUP TAX FOR BILLING NORTH BEND MEDICAL CENTER | OTHER | 1407812365 | 01 | OR | GROUP NPI NORTH BEND MEDICAL CENTER | OTHER | 161133 | 01 | OR | GROUP MEDICAID NORTH BEND MEDICAL CENTER | OTHER |