MEDICARE: FUTURES OUTPATIENT SURGICAL CENTER

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	071440	OR

Other Identifiers

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

General Provider Information

NPI Number	:	1518022615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FUTURES OUTPATIENT SURGICAL CENTER

Provider Business Mailing Address
First Line	:	1849 NW KEARNEY ST STE 302
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97209-1453
Country	:	US
Telephone Number	:	503-525-3653
Fax Number	:	503-224-9081

Provider Business Practice Location Address
First Line	:	1849 NW KEARNEY ST STE 302
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97209-1453
Country	:	US
Telephone Number	:	503-525-3653
Fax Number	:	503-224-9081

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRYCE E POTTER
Credential	:	MD, DMD, FACS
Telephone Number	:	503-224-1371

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	08/22/2020

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