Provider Demographics
NPI:1972902286
Name:OREGON SPECIALISTS SURGERY CENTER LLC
Entity type:Organization
Organization Name:OREGON SPECIALISTS SURGERY CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GIESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-301-8500
Mailing Address - Street 1:2785 RIVER RD S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5883
Mailing Address - Country:US
Mailing Address - Phone:971-301-8500
Mailing Address - Fax:971-301-8501
Practice Address - Street 1:2785 RIVER RD S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-5883
Practice Address - Country:US
Practice Address - Phone:971-301-8500
Practice Address - Fax:971-301-8501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-22
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500690486Medicaid
OR38-C0001107Medicare PIN