1467628735 NPI number — DR SURAH HIRSCH DC & ASSOC PC

Table of content: (NPI 1467628735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467628735 NPI number — DR SURAH HIRSCH DC & ASSOC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR SURAH HIRSCH DC & ASSOC 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:
Provider Other Organization Name Type Code:
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:
1467628735
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3151 NE SANDY BLVD
Provider Second Line Business Mailing Address:
STE. 200
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97232-2500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-238-9788
Provider Business Mailing Address Fax Number:
503-233-9163

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3151 NE SANDY BLVD
Provider Second Line Business Practice Location Address:
STE. 200
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97232-2500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-238-9788
Provider Business Practice Location Address Fax Number:
503-233-9163
Provider Enumeration Date:
05/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HIRSCH
Authorized Official First Name:
SURAH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
503-238-9788

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  OR 2037 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0000QGFWM . This is a "MEDICARE ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 08042100 . This is a "REGENCE BCBS OF OREGON" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com