1386730026 NPI number — STARR-WOOD CARDIAC GROUP OF PORTLAND PC

Table of content: (NPI 1386730026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386730026 NPI number — STARR-WOOD CARDIAC GROUP OF PORTLAND PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STARR-WOOD CARDIAC GROUP OF PORTLAND PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NORTHSTARR CARDIOTHORACIC SURGERY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386730026
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9135 SW BARNES RD STE 963
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97225-6699
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-297-1419
Provider Business Mailing Address Fax Number:
503-216-2488

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9135 SW BARNES RD STE 963
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97225-6699
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-297-1419
Provider Business Practice Location Address Fax Number:
503-216-2488
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FLOTEN
Authorized Official First Name:
H
Authorized Official Middle Name:
STORM
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
503-297-1419

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com