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General NPI Number Information
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NPI Number | 1245336411
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Entity Type | Organization
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Legal Business Name | LOVEJOY SURGICENTER INC.
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 933 NW 25TH AVE
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City | PORTLAND
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State | OR
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Zip | 97210-2829
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Country | US
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Telephone | 203-221-1870
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Fax | 503-221-1488
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Provider Business Mailing Address
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Address Line | 933 NW 25TH AVE
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City | PORTLAND
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State | OR
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Zip | 97210-2829
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Country | US
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Telephone | 203-221-1870
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Fax | 503-221-1488
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KAYLA REICH
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Credential |
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Telephone | 503-221-1870
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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 | 07 0978
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License Number State | OR
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