AMBROSE K SU (NPI# 1588649297) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588649297 |
| Entity Type | Individual |
| Full Name | AMBROSE K SU |
| Credential | DPM |
| Practice Address |
2408 Ne Division St Bend OR 97701-3543 |
| Practice Telephone | 5413882861 |
| Practice Fax Number | 5413826297 |
| Mailing Telephone | 5413882861 |
| Mailing Fax Number | 5413826297 |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2013-01-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 213E00000X | Podiatrist | DP00159 | OR | Podiatric Medicine & Surgery Service Providers |
| N | 213E00000X | Podiatrist | DPOO159 | OR | Podiatric Medicine & Surgery Service Providers |
| N | 213ES0000X |
Podiatrist Specialization: Sports Medicine |
DP00159 | OR | Podiatric Medicine & Surgery Service Providers |
| N | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
DP00159 | OR | Podiatric Medicine & Surgery Service Providers |
| Y | 213ES0131X |
Podiatrist Specialization: Foot Surgery |
DP00159 | OR | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | CLEAR CHOICE HEALTH PLANS | 13578 | 01 |
| OR | RR MEDICARE | 480031260 | 01 |
| OR | 214619 | 05 | |
| OR | BLUE CROSS | 024734001 | 01 |
| Street Address |
2408 NE DIVISION ST |
| City | BEND |
| State | OR |
| Zip Code | 97701-3543 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619951456 | Patrick J Evoy | Podiatrist | 2408 Ne Division St, Bend, OR 97701-3543 | 2005-12-05 |
| 1700318755 | Cascade Medical Care,llc | Licensed Practical Nurse | 2408 Ne Division St, Bend, OR 97703-3543 | 2017-03-29 |
| 1982870721 | Jeremy Dahlenburg | Podiatrist | 2408 Ne Division St, Bend, OR 97701-3543 | 2008-05-01 |
| 1790987428 | Cascade Foot Clinic | Podiatrist | 2408 Ne Division St, Bend, OR 97701-3543 | 2007-06-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104465525 | Andrew Kyle Burzynski | Denturist | 853 Ne 4th St., Bend, OR 97701 | 2020-01-02 |
| 1013480714 | Andrew Traut | Specialist/Technologist | Oregon State Force Lab, 2200 Ne Neff Rd Suite 202, Bend, OR 97701 | 2019-01-04 |
| 1871063917 | Calley Asbill, Nd LLC | Chiropractor | 2146 Ne 4th Street, Suite 160, Bend, OR 97701 | 2018-12-02 |
| 1902372212 | Carisa S Battin | Counselor | 361 Ne Franklin Avenue Bldg E #4, Bend, OR 97701 | 2018-10-15 |
| 1366921223 | Hillside Eye Center LLC | Ophthalmology | 625 Nw Colorado Avenue, Bend, OR 97701 | 2018-08-11 |
| 1528545514 | Kellie Michiko Kawasaki-jones | Dentist | 62968 Ob Riley Road, Suite 12, Bend, OR 97701 | 2018-07-23 |
| 1992255327 | Shelby Chiropractic | Chiropractor | 561 Ne Bellevue Dr Ste 102, Bend, OR 97701 | 2016-10-10 |
| 1144671520 | Kevin Richard Pett | Acupuncturist | 39 Nw Louisanna Ave., Hawthorn Healing Arts Center, Bend, OR 97701 | 2016-06-27 |
| 1912357500 | Sheldon Shawn Doveri | Driver | 233 Nw Revere Ave, Bend, OR 97701 | 2016-06-15 |
| 1740647411 | Anne Power | Homeopath | 2100 Ne Neff Rd Suite B, Bend, OR 97701 | 2016-01-26 |
| Find all providers in zip 97701 | ||||
| Taxonomy Code | 213ES0131X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083991400 | Larry D Jensen Dpm PC | Podiatrist | 11815 Sw King James Pl, Suite 60, Tigard, OR 97224-2478 | 2011-11-14 |
| 1992942064 | Lester Tengsico LLC | Podiatrist | 10424 Se Cherry Blossom Dr Ste F, Portland, OR 97216-2825 | 2009-01-12 |
| 1346347432 | Brian Douglas Ashdown | Podiatrist | 2605 Willetta St Sw Ste D2, Albany, OR 97321-3451 | 2006-09-20 |
| 1356452247 | Stephen Fekete | Podiatrist | 29756 Sw Town Center Loop W Ste H, Wilsonville, OR 97070-6482 | 2006-08-31 |
| 1811006596 | Joshua P Mitnick | Podiatrist | 8305 Se Monterey Ave., #101, Portland, OR 97266 | 2006-08-29 |
| 1760434674 | David C Greenberg | Podiatrist | 948 Ne 102nd Ave, Suite 103, Portland, OR 97220-4064 | 2006-05-17 |
| 1134102320 | Steven Gary Tillett | Podiatrist | 6274 Sw Capitol Hwy, Portland, OR 97239-2674 | 2005-11-22 |
| 1851383269 | Larry Dean Jensen | Podiatrist | 11815 Sw King James Place, Suite 60, Tigard, OR 97224 | 2005-08-22 |
| 1790295228 | Clarke Podiatry, LLC | Podiatrist | 113 S Main St, Milton Freewater, OR 97862-1342 | 2017-10-11 |
| 1518146984 | Patricia Eileen Cain | Podiatrist | 1510 Division St, Suite 80, Oregon City, OR 97045-1581 | 2007-11-01 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.