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NPI Code Detail

MEDICARE: RIVER ROAD SURGERY CENTER LLC

MEDICARE: RIVER ROAD 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
1261QA1903XAmbulatory Surgical Clinic/Center07 1529OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487620472
Entity Type Code : Organization
Provider Name (Legal Business Name) : RIVER ROAD SURGERY CENTER LLC
Provider Business Mailing Address
First Line : 3099 RIVER RD S
Second Line : SUITE 100
City : SALEM
State : OR
Zip : 97302-9754
Country : US
Telephone Number : 503-361-3094
Fax Number : 503-485-2168
Provider Business Practice Location Address
First Line : 3099 RIVER RD S
Second Line : SUITE 100
City : SALEM
State : OR
Zip : 97302-9754
Country : US
Telephone Number : 503-361-3094
Fax Number : 503-485-2168
Authorized Official
Title or Position : BUSINESS OFFICE SUPERVISOR
Name : MRS. ROCHELL ANN BLAIR HOLMES
Credential :
Telephone Number : 503-485-2584
Provider Enumeration Date : 02/28/2006
Last Update Date : 02/25/2008

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Directions to “RIVER ROAD SURGERY CENTER LLC ” Practice Location

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