MEDICARE: OREGON OUTPATIENT SURGERY CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	393476	OR

General Provider Information

NPI Number	:	1124026745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OREGON OUTPATIENT SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	7300 SW CHILDS RD
Second Line	:	SUITE A
City	:	TIGARD
State	:	OR
Zip	:	97224-7713
Country	:	US
Telephone Number	:	503-612-8452
Fax Number	:	503-207-5368

Provider Business Practice Location Address
First Line	:	7300 SW CHILDS RD
Second Line	:	SUITE A
City	:	TIGARD
State	:	OR
Zip	:	97224-7713
Country	:	US
Telephone Number	:	503-612-8452
Fax Number	:	503-207-5368

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MS. GALE V STOVERN
Credential	:
Telephone Number	:	503-612-8452

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	08/22/2020

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