Healthcare Provider Details

I. General information

NPI: 1518994243
Provider Name (Legal Business Name): SILVERTON ANESTHESIA GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 FAIRVIEW ST
SILVERTON OR
97381
US

IV. Provider business mailing address

1000 WILLAGILLESPIE RD 350
EUGENE OR
97401-2178
US

V. Phone/Fax

Practice location:
  • Phone: 503-873-1500
  • Fax:
Mailing address:
  • Phone: 541-343-0952
  • Fax: 503-343-8034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ERLING Y CHAVEZ
Title or Position: MANAGER MEMBER
Credential: CRNA
Phone: 503-873-1500