MEDICARE: GSO EQUIPMENT CORP

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	261QE0800X	Endoscopy Clinic/Center	07-1625	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	:	1922558055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GSO EQUIPMENT CORP

Provider Business Mailing Address
First Line	:	541 NE 20TH AVE STE 225
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-2895
Country	:	US
Telephone Number	:	503-963-2801
Fax Number	:	503-963-2825

Provider Business Practice Location Address
First Line	:	1130 MOLALLA AVE
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-3740
Country	:	US
Telephone Number	:	503-692-3750
Fax Number	:	503-691-2324

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RICHARD JAMISON
Credential	:	M.D.
Telephone Number	:	503-963-2801

Provider Enumeration Date	:	10/13/2016
Last Update Date	:	02/27/2024

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Directions to “GSO EQUIPMENT CORP ” Practice Location

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