Provider Demographics
NPI:1891127981
Name:PLAZA AMBULATORY SURGERY CENTER LLC
Entity Type:Organization
Organization Name:PLAZA AMBULATORY SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:971-229-8100
Mailing Address - Street 1:5050 NE HOYT ST
Mailing Address - Street 2:SUITE 156
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2991
Mailing Address - Country:US
Mailing Address - Phone:971-229-8100
Mailing Address - Fax:971-229-8101
Practice Address - Street 1:5050 NE HOYT ST
Practice Address - Street 2:SUITE 156
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2991
Practice Address - Country:US
Practice Address - Phone:971-229-8100
Practice Address - Fax:971-229-8101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical