Healthcare Provider Details

I. General information

NPI: 1811978356
Provider Name (Legal Business Name): WESTSIDE SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13240 SW PACIFIC HWY SUITE 200
TIGARD OR
97223-4828
US

IV. Provider business mailing address

11086 SE OAK ST
MILWAUKIE OR
97222-6692
US

V. Phone/Fax

Practice location:
  • Phone: 503-639-6571
  • Fax: 503-624-6037
Mailing address:
  • Phone: 503-557-2020
  • Fax: 503-344-5110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number07-1548
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number07-1548
License Number StateOR

VIII. Authorized Official

Name: BRETT WILLIAMS
Title or Position: CEO
Credential:
Phone: 503-558-7372