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General NPI Number Information
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NPI Number | 1407997125
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Entity Type | Organization
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Legal Business Name | PEARL SURGICENTER, LLC
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 120 NW 14TH AVE SUITE 200
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City | PORTLAND
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State | OR
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Zip | 97209-2643
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Country | US
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Telephone | 503-771-1883
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Fax |
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Provider Business Mailing Address
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Address Line | 120 NW 14TH AVE SUITE 200
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City | PORTLAND
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State | OR
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Zip | 97209-2643
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Country | US
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Telephone | 503-771-1883
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | RICHARD BRIAN ROSENFIELD
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Credential | M.D.
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Telephone | 503-771-1883
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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 | 676749.00
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License Number State | OR
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