Provider Demographics
NPI:1740394741
Name:YAMHILL VALLEY SURGICAL CENTER INC.
Entity Type:Organization
Organization Name:YAMHILL VALLEY SURGICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-474-0650
Mailing Address - Street 1:PO BOX 1359
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-1359
Mailing Address - Country:US
Mailing Address - Phone:503-474-0650
Mailing Address - Fax:503-474-0499
Practice Address - Street 1:2375 NE CUMULUS AVE
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-8861
Practice Address - Country:US
Practice Address - Phone:503-474-0650
Practice Address - Fax:503-474-0499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR07-1533261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR268707Medicaid
X67963Medicare UPIN
OR268707Medicaid