Healthcare Provider Details

I. General information

NPI: 1801097407
Provider Name (Legal Business Name): FOUR RIVERS ANESTHESIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 11/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 SW 9TH ST
ONTARIO OR
97914
US

IV. Provider business mailing address

5319 SW WESTGATE DR #241
PORTLAND OR
97221-2432
US

V. Phone/Fax

Practice location:
  • Phone: 541-889-5331
  • Fax:
Mailing address:
  • Phone: 503-297-7223
  • Fax: 503-297-7603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number096007764CRNA
License Number StateOR

VIII. Authorized Official

Name: MR. MICHAEL E OHARA
Title or Position: OWNER
Credential: CRNA
Phone: 208-642-9293