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General NPI Number Information
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NPI Number | 1154010429
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Entity Type | Organization
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Legal Business Name | PREMIER ANESTHESIA OF OREGON PC
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Dates
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Enumeration Date | 05/03/2023
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Last Update Date | 05/03/2023
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Provider Practice Location Address
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Address Line | 1001 N PROVIDENCE DR
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City | NEWBERG
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State | OR
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Zip | 97132-7485
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Country | US
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Telephone | 678-690-7816
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Fax |
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Provider Business Mailing Address
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Address Line | 2655 NORTHWINDS PKWY
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City | ALPHARETTA
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State | GA
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Zip | 30009-2280
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP FINANCE
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Name | RANDY WALKER
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Credential |
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Telephone | 678-690-7812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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