Provider Demographics
NPI:1669417176
Name:ON-SITE ANESTHESIA SERVICES INC
Entity type:Organization
Organization Name:ON-SITE ANESTHESIA SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:C
Authorized Official - Last Name:DIGGLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-548-4770
Mailing Address - Street 1:PO BOX 4800
Mailing Address - Street 2:UNIT 38
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4800
Mailing Address - Country:US
Mailing Address - Phone:503-655-3851
Mailing Address - Fax:503-655-3318
Practice Address - Street 1:333 S STATE ST # V111
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3932
Practice Address - Country:US
Practice Address - Phone:503-548-4770
Practice Address - Fax:503-655-3318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR286978Medicaid
OR112333Medicare PIN
OR286978Medicaid