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General NPI Number Information
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NPI Number | 1174858955
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Entity Type | Organization
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Legal Business Name | WEST PORTLAND SURGERY CENTER, LLC
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Dates
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Enumeration Date | 10/12/2009
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Last Update Date | 07/21/2014
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Provider Practice Location Address
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Address Line | 16985 NW CORNELL RD
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City | BEAVERTON
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State | OR
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Zip | 97006-5639
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Country | US
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Telephone | 503-533-4800
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Fax | 503-533-4884
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Provider Business Mailing Address
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Address Line | 16985 NW CORNELL RD
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City | BEAVERTON
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State | OR
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Zip | 97006-5639
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Country | US
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Telephone | 503-533-4800
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Fax | 503-533-4884
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LISA A DEAN
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Credential | RN, CLNC
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Telephone | 503-533-4800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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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 | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 25323
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License Number State | OR
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