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General NPI Number Information
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NPI Number | 1851520514
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Entity Type | Organization
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Legal Business Name | CAPITOL SURGERY CENTER LLC
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Dates
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Enumeration Date | 07/02/2009
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Last Update Date | 12/16/2021
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Provider Practice Location Address
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Address Line | 633 WAVERLY DR SE
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City | ALBANY
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State | OR
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Zip | 97322-5078
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Country | US
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Telephone | 541-918-4210
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Fax | 541-918-4215
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Provider Business Mailing Address
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Address Line | 633 WAVERLY DR SE
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City | ALBANY
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State | OR
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Zip | 97322-5078
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Country | US
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Telephone | 541-918-4210
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Fax | 541-918-4215
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JENNIFER D KOLB
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Credential |
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Telephone | 541-918-4210
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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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