1629080510 NPI number — SURGICAL ONCOLOGY ASSOCIATES, P,C.

Table of content: (NPI 1629080510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629080510 NPI number — SURGICAL ONCOLOGY ASSOCIATES, P,C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICAL ONCOLOGY ASSOCIATES, P,C.
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:
1629080510
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5050 NE HOYT ST
Provider Second Line Business Mailing Address:
SUITE 410
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97213-2991
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-231-0377
Provider Business Mailing Address Fax Number:
503-231-2816

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5050 NE HOYT ST
Provider Second Line Business Practice Location Address:
SUITE 410
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97213-2991
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-231-0377
Provider Business Practice Location Address Fax Number:
503-231-2816
Provider Enumeration Date:
08/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LIM
Authorized Official First Name:
CAROLYN
Authorized Official Middle Name:
YEECHING
Authorized Official Title or Position:
CLINIC ADMINISTRATOR
Authorized Official Telephone Number:
503-231-0377

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1609888544 . This is a "SCOTT J. SOOT MD" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 1891707766 . This is a "JAMES H IMATANI MD" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 1679585558 . This is a "CHRISTOPHER N.H. LIM MD" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 1700898723 . This is a "KELVIN C. YU MD" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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