Healthcare Provider Details

I. General information

NPI: 1295738375
Provider Name (Legal Business Name): OREGON SURGICENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 HARTMAN LN STE 300
SPRINGFIELD OR
97477-1198
US

IV. Provider business mailing address

2400 HARTMAN LN STE 300
SPRINGFIELD OR
97477-1198
US

V. Phone/Fax

Practice location:
  • Phone: 541-343-1603
  • Fax: 541-687-0281
Mailing address:
  • Phone: 541-343-1603
  • Fax: 541-687-0281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number393786
License Number StateOR

VIII. Authorized Official

Name: TERRANCE FITZPATRICK
Title or Position: ADMINISTRATOR
Credential:
Phone: 541-334-3350