=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821019860
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SURGICAL ASSOCIATS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2006
-----------------------------------------------------
Last Update Date | 02/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9427 SW BARNES ROAD SUITE 599
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97225-6635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-292-1103
-----------------------------------------------------
Fax | 503-292-1433
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9427 SW BARNES ROAD SUITE 599
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97225-6635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-292-1103
-----------------------------------------------------
Fax | 503-292-1433
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD/OWNER
-----------------------------------------------------
Name | CHELSEA SEARE HARDIN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 503-292-1103
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------