# NORTHWEST AMBULATORY SURGERY CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Northwest Ambulatory Surgery Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245482280
- **Authorized official:** ERIC BOON (OFFICER/AUTHORIZED OFFICIAL)
- **Authorized official phone:** (480) 567-0269

## Contact information

- **Practice address:** 1515 NW 18TH AVE, STE 200, PORTLAND, OR 97209-2516
- **Practice address phone:** (503) 542-4888
- **Practice address fax:** (503) 542-2813
- **Mailing address:** 14201 DALLAS PKWY, DALLAS, TX 75254-2916
- **Mailing address phone:** (503) 542-4888
- **Mailing address fax:** (503) 542-2813

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 07 1564 | OR | Yes |

## Other

- **Enumeration date:** 10/22/2008
- **Last updated:** 10/14/2024