Provider Demographics
NPI:1609896539
Name:CEDAR HILLS AMBULATORY SURGERY CENTER LLC
Entity Type:Organization
Organization Name:CEDAR HILLS AMBULATORY SURGERY CENTER LLC
Other - Org Name:CEDAR HILLS SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-222-0334
Mailing Address - Street 1:10305 SW PARK WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5033
Mailing Address - Country:US
Mailing Address - Phone:971-222-0334
Mailing Address - Fax:971-222-0337
Practice Address - Street 1:10305 SW PARK WAY STE 101
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5033
Practice Address - Country:US
Practice Address - Phone:971-222-0334
Practice Address - Fax:971-222-0337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR071576261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR38C0001077Medicare PIN