1548453558 NPI number — SURGICAL ASSISTANT SERVICES, INC.

Table of content: (NPI 1548453558)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548453558 NPI number — SURGICAL ASSISTANT SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICAL ASSISTANT SERVICES, INC.
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:
1548453558
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2264
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAVERTON
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97075-2264
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
971-506-6870
Provider Business Mailing Address Fax Number:
503-642-9434

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9432 SW 164TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAVERTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97007-9415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
971-506-6870
Provider Business Practice Location Address Fax Number:
503-642-9434
Provider Enumeration Date:
08/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GIBBENS
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
RN/RNFA
Authorized Official Telephone Number:
971-506-6870

Provider Taxonomy Codes

  • Taxonomy code: 163WR0006X , with the licence number:  094000296RN , 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: 240297 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 341686 . This is a "PROVIDENCE HEALTH PLANS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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