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General NPI Number Information
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NPI Number | 1538146931
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Entity Type | Organization
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Legal Business Name | WILLAMETTE SURGERY CENTER LLC
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Dates
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Enumeration Date | 12/27/2005
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 1445 STATE ST
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City | SALEM
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State | OR
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Zip | 97301-4248
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Country | US
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Telephone | 503-566-3507
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Fax |
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Provider Business Mailing Address
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Address Line | 665 WINTER STREET ATTN: CARLA REILLY
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City | SALEM
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State | OR
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Zip | 97301
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Country | US
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Telephone | 503-566-3507
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LORISSA ADDABBO
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Credential |
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Telephone | 503-566-3507
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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 | 071522
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License Number State | OR
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