Provider Demographics
NPI:1295738375
Name:OREGON SURGICENTER LLC
Entity type:Organization
Organization Name:OREGON SURGICENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-334-3350
Mailing Address - Street 1:2400 HARTMAN LN
Mailing Address - Street 2:STE 300
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-1198
Mailing Address - Country:US
Mailing Address - Phone:541-343-1603
Mailing Address - Fax:541-687-0281
Practice Address - Street 1:2400 HARTMAN LN
Practice Address - Street 2:STE 300
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1198
Practice Address - Country:US
Practice Address - Phone:541-343-1603
Practice Address - Fax:541-687-0281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR393786261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00175746OtherRAILROAD MEDICARE
OR277843Medicaid
OR277843Medicaid