Provider Demographics
NPI:1417278011
Name:WILSHIRE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:WILSHIRE SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE /CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:FATHEREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-688-5187
Mailing Address - Street 1:9775 SW WILSHIRE ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5020
Mailing Address - Country:US
Mailing Address - Phone:503-688-5187
Mailing Address - Fax:503-688-5199
Practice Address - Street 1:9775 SW WILSHIRE ST
Practice Address - Street 2:SUITE 250
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5020
Practice Address - Country:US
Practice Address - Phone:503-688-5187
Practice Address - Fax:503-688-5199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-17
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical