Healthcare Provider Details

I. General information

NPI: 1831184019
Provider Name (Legal Business Name): REDMOND SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 NW KINGWOOD AVE STE A
REDMOND OR
97756-1688
US

IV. Provider business mailing address

244 NW KINGWOOD AVE STE A
REDMOND OR
97756-1688
US

V. Phone/Fax

Practice location:
  • Phone: 541-316-2500
  • Fax: 541-316-2513
Mailing address:
  • Phone: 541-316-2500
  • Fax: 541-316-2513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number071571
License Number StateOR

VIII. Authorized Official

Name: KATHERINE L. REED
Title or Position: AUTHORIZED OFFICIAL - OFFICER
Credential:
Phone: 972-763-3859