Provider Demographics
NPI:1124026745
Name:OREGON OUTPATIENT SURGERY CENTER LLC
Entity Type:Organization
Organization Name:OREGON OUTPATIENT SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GALE
Authorized Official - Middle Name:V
Authorized Official - Last Name:STOVERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-612-8452
Mailing Address - Street 1:7300 SW CHILDS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7713
Mailing Address - Country:US
Mailing Address - Phone:503-612-8452
Mailing Address - Fax:503-207-5368
Practice Address - Street 1:7300 SW CHILDS RD
Practice Address - Street 2:SUITE A
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7713
Practice Address - Country:US
Practice Address - Phone:503-612-8452
Practice Address - Fax:503-207-5368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR393476261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR118255Medicare ID - Type Unspecified