Healthcare Provider Details

I. General information

NPI: 1104993286
Provider Name (Legal Business Name): SILVERTON SURGICAL,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 WELCH ST
SILVERTON OR
97381-1934
US

IV. Provider business mailing address

450 WELCH ST
SILVERTON OR
97381-1934
US

V. Phone/Fax

Practice location:
  • Phone: 503-873-5310
  • Fax: 503-873-5315
Mailing address:
  • Phone: 503-873-5310
  • Fax: 503-873-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateOR

VIII. Authorized Official

Name: DR. HARRIS J WATERS
Title or Position: ADMINISTRATOR
Credential: M.D.
Phone: 503-873-5310