Healthcare Provider Details

I. General information

NPI: 1760595797
Provider Name (Legal Business Name): SILVERTON HOSPITAL DBA TUKWILA MEDICAL SPECIALIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

693 GLATT CIR # 4
WOODBURN OR
97071-9600
US

IV. Provider business mailing address

693 GLATT CIR # 4
WOODBURN OR
97071-9600
US

V. Phone/Fax

Practice location:
  • Phone: 503-982-4878
  • Fax:
Mailing address:
  • Phone: 503-982-4878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NICHOLE MARIE POWERS
Title or Position: CLINIC MANAGER
Credential:
Phone: 503-874-2458