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Organization
BOARDMAN SURGICAL LLC
Active
Organization
BOARDMAN SURGICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELLIE BOARDMAN CSFA (OWNER)
(503) 307-0159
Entity
Organization
Contact information
Practice address
15074 SE BEVINGTON AVE, MILWAUKIE, OR 97267-3357
(503) 307-0159
Mailing address
15074 SE BEVINGTON AVE, MILWAUKIE, OR 97267-3357
(503) 307-0159
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
—
NULL
246ZC0007X
Surgical Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
—
NULL
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
02/02/2021
Last updated
02/03/2021
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