Provider Demographics
NPI:1578510178
Name:PACIFIC NEUROSURGICAL PC
Entity Type:Organization
Organization Name:PACIFIC NEUROSURGICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERSON
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-528-0704
Mailing Address - Street 1:501 N GRAHAM ST
Mailing Address - Street 2:SUITE 580
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1654
Mailing Address - Country:US
Mailing Address - Phone:503-528-0704
Mailing Address - Fax:503-528-0708
Practice Address - Street 1:501 N GRAHAM ST
Practice Address - Street 2:SUITE 580
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1654
Practice Address - Country:US
Practice Address - Phone:503-528-0704
Practice Address - Fax:503-528-0708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR134321Medicaid