Provider Demographics
NPI:1043374648
Name:GEORGE KUBAC MD PC
Entity type:Organization
Organization Name:GEORGE KUBAC MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUBAC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-884-6233
Mailing Address - Street 1:PO BOX 5109
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-0119
Mailing Address - Country:US
Mailing Address - Phone:541-882-1540
Mailing Address - Fax:541-882-2583
Practice Address - Street 1:2614 CLOVER ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1132
Practice Address - Country:US
Practice Address - Phone:541-884-6233
Practice Address - Fax:541-880-2840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20381207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CH2248OtherRAILROAD MEDICARE
OR288168Medicaid
CH2248OtherRAILROAD MEDICARE
ORR142453Medicare PIN