Provider Demographics
NPI:1912177163
Name:SURGERY CENTER AT TANASBOURNE, LLC
Entity Type:Organization
Organization Name:SURGERY CENTER AT TANASBOURNE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-216-9500
Mailing Address - Street 1:18650 NW CORNELL RD STE 110
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-9208
Mailing Address - Country:US
Mailing Address - Phone:503-216-9500
Mailing Address - Fax:503-216-9535
Practice Address - Street 1:18650 NW CORNELL ROAD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-9223
Practice Address - Country:US
Practice Address - Phone:503-215-8584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical