1154327658 NPI number — PORTLAND SURGICAL ONCOLOGY, PC

Table of content: (NPI 1154327658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154327658 NPI number — PORTLAND SURGICAL ONCOLOGY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PORTLAND SURGICAL ONCOLOGY, 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:
1154327658
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2579
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:
97208-2579
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-356-9166
Provider Business Mailing Address Fax Number:
503-771-7221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5050 NE HOYT ST
Provider Second Line Business Practice Location Address:
STE 317
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97213-2982
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-239-0092
Provider Business Practice Location Address Fax Number:
503-239-0195
Provider Enumeration Date:
06/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FRIEDMAN
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
IAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
503-239-0092

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)





Copyright © 2007-2024 www.npivalidator.com