Provider Demographics
NPI:1710992680
Name:AMBULATORY SURGICAL CENTER
Entity Type:Organization
Organization Name:AMBULATORY SURGICAL CENTER
Other - Org Name:AESTHETIC BREAST AND COSMETIC SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:V
Authorized Official - Last Name:DEMARS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-253-3458
Mailing Address - Street 1:10201 SE MAIN ST STE 20
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2937
Mailing Address - Country:US
Mailing Address - Phone:503-253-3458
Mailing Address - Fax:503-253-0856
Practice Address - Street 1:10201 SE MAIN ST STE 20
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2937
Practice Address - Country:US
Practice Address - Phone:503-253-3458
Practice Address - Fax:503-253-0856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR071438261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical