Provider Demographics
NPI:1467484956
Name:EAST PORTLAND SURGICAL CENTER LLC
Entity Type:Organization
Organization Name:EAST PORTLAND SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALVERA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GASKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-772-6160
Mailing Address - Street 1:9200 SE 91ST AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-6756
Mailing Address - Country:US
Mailing Address - Phone:503-772-6160
Mailing Address - Fax:503-772-6161
Practice Address - Street 1:9200 SE 91ST AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-6756
Practice Address - Country:US
Practice Address - Phone:503-772-6160
Practice Address - Fax:503-772-6161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR071572261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical