Healthcare Provider Details

I. General information

NPI: 1265062202
Provider Name (Legal Business Name): RESURGENT HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2020
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 SE POWELL VALLEY RD STE 205A
GRESHAM OR
97080-1489
US

IV. Provider business mailing address

13203 SE 172ND AVE STE 166
HAPPY VALLEY OR
97086-8738
US

V. Phone/Fax

Practice location:
  • Phone: 503-484-6128
  • Fax:
Mailing address:
  • Phone: 503-484-6128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BENJAMIN L. HEATH
Title or Position: OWNER
Credential: DC
Phone: 503-484-6128