Provider Demographics
NPI:1366638843
Name:MERIDIAN CENTER FOR SURGICAL EXCELLENCE
Entity Type:Organization
Organization Name:MERIDIAN CENTER FOR SURGICAL EXCELLENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:CONNALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-783-0542
Mailing Address - Street 1:19801 SW 72ND AVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-8351
Mailing Address - Country:US
Mailing Address - Phone:503-783-0542
Mailing Address - Fax:503-783-0545
Practice Address - Street 1:19801 SW 72ND AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8351
Practice Address - Country:US
Practice Address - Phone:503-783-0542
Practice Address - Fax:503-783-0545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical