Provider Demographics
NPI:1720100753
Name:HILLSBORO NEUROSURGICAL ASSOCIATES, PC
Entity type:Organization
Organization Name:HILLSBORO NEUROSURGICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:C
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:503-352-1141
Mailing Address - Street 1:333 SE 7TH AVE
Mailing Address - Street 2:SUITE 4250
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4157
Mailing Address - Country:US
Mailing Address - Phone:503-352-1141
Mailing Address - Fax:503-352-1147
Practice Address - Street 1:333 SE 7TH AVE
Practice Address - Street 2:SUITE 4250
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4157
Practice Address - Country:US
Practice Address - Phone:503-352-1141
Practice Address - Fax:503-352-1147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24895207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR117660Medicare ID - Type UnspecifiedPRACTICE MEDICARE NUMBER