1831184019 NPI number — REDMOND SURGERY CENTER, LLC

Table of content: (NPI 1831184019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831184019 NPI number — REDMOND SURGERY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REDMOND SURGERY CENTER, LLC
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:
REDMOND SURGERY CENTER
Provider Other Organization Name Type Code:
5
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:
1831184019
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
244 NW KINGWOOD AVE
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
REDMOND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97756-1688
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-316-2500
Provider Business Mailing Address Fax Number:
541-316-2513

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
244 NW KINGWOOD AVE
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
REDMOND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97756-1688
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-316-2500
Provider Business Practice Location Address Fax Number:
541-316-2513
Provider Enumeration Date:
09/14/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
REED
Authorized Official First Name:
KATHERINE
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
AUTHORIZED OFFICIAL - OFFICER
Authorized Official Telephone Number:
972-763-3859

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  071571 , 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)