Provider Demographics
NPI:1003914243
Name:STARK STREET PLAZA, LLC
Entity Type:Organization
Organization Name:STARK STREET PLAZA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAMMAI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCKOVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-492-6510
Mailing Address - Street 1:24076 SE STARK ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3373
Mailing Address - Country:US
Mailing Address - Phone:503-492-6510
Mailing Address - Fax:503-492-6502
Practice Address - Street 1:24076 SE STARK ST
Practice Address - Street 2:SUITE 310
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3373
Practice Address - Country:US
Practice Address - Phone:503-492-6510
Practice Address - Fax:503-492-6502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical