Healthcare Provider Details

I. General information

NPI: 1114830643
Provider Name (Legal Business Name): PORTLAND ORTHOPEDIC SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9555 SW BARNES RD STE 301
PORTLAND OR
97225-6670
US

IV. Provider business mailing address

9555 SW BARNES RD STE 301
PORTLAND OR
97225-6670
US

V. Phone/Fax

Practice location:
  • Phone: 971-430-4070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MADISON AUSTIN
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 615-585-6074