Healthcare Provider Details

I. General information

NPI: 1386730026
Provider Name (Legal Business Name): STARR-WOOD CARDIAC GROUP OF PORTLAND PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9135 SW BARNES RD STE 963
PORTLAND OR
97225-6699
US

IV. Provider business mailing address

9135 SW BARNES RD STE 963
PORTLAND OR
97225-6699
US

V. Phone/Fax

Practice location:
  • Phone: 503-297-1419
  • Fax: 503-216-2488
Mailing address:
  • Phone: 503-297-1419
  • Fax: 503-216-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: H STORM FLOTEN
Title or Position: PRESIDENT
Credential: MD
Phone: 503-297-1419