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General NPI Number Information
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NPI Number | 1366638843
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Entity Type | Organization
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Legal Business Name | MERIDIAN CENTER FOR SURGICAL EXCELLENCE
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 09/19/2007
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Provider Practice Location Address
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Address Line | 19801 SW 72ND AVE SUITE 170
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City | TUALATIN
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State | OR
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Zip | 97062-8351
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Country | US
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Telephone | 503-783-0542
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Fax | 503-783-0545
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Provider Business Mailing Address
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Address Line | 19801 SW 72ND AVE SUITE 170
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City | TUALATIN
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State | OR
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Zip | 97062-8351
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Country | US
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Telephone | 503-783-0542
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Fax | 503-783-0545
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. TIMOTHY PATRICK CONNALL
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Credential | MD
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Telephone | 503-783-0542
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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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