Provider Demographics
NPI:1821019860
Name:SURGICAL ASSOCIATS, PC
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:SEARE
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-292-1103
Mailing Address - Street 1:9427 SW BARNES ROAD
Mailing Address - Street 2:SUITE 599
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6635
Mailing Address - Country:US
Mailing Address - Phone:503-292-1103
Mailing Address - Fax:503-292-1433
Practice Address - Street 1:9427 SW BARNES ROAD
Practice Address - Street 2:SUITE 599
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6635
Practice Address - Country:US
Practice Address - Phone:503-292-1103
Practice Address - Fax:503-292-1433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500672699Medicaid
WA2094451Medicaid
OR060488Medicaid