Provider Demographics
NPI:1962158592
Name:PPSG ACQUISITION ENTITY, LLC
Entity type:Organization
Organization Name:PPSG ACQUISITION ENTITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:503-208-3404
Mailing Address - Street 1:1200 NW NAITO PKWY STE 320
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2829
Mailing Address - Country:US
Mailing Address - Phone:503-208-3404
Mailing Address - Fax:
Practice Address - Street 1:1200 NW NAITO PKWY STE 320
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2829
Practice Address - Country:US
Practice Address - Phone:503-208-3404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical