Healthcare Provider Details

I. General information

NPI: 1336077742
Provider Name (Legal Business Name): OATH EAST PORTLAND SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 NW COUNCIL DR STE 212
GRESHAM OR
97030-3724
US

IV. Provider business mailing address

831 NW COUNCIL DR STE 212
GRESHAM OR
97030-3724
US

V. Phone/Fax

Practice location:
  • Phone: 203-451-8921
  • Fax:
Mailing address:
  • Phone: 203-451-8921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANDA LEIGH GUNTHEL
Title or Position: HEAD OF OPERATIONS/ADMINISTRATOR
Credential:
Phone: 203-451-8921