# WILSHIRE SURGERY CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417278011
- **Authorized official:** STEPHANIE D FATHEREE (REVENUE /CREDENTIALING SPECIALIST)
- **Authorized official phone:** (503) 688-5187

## Contact information

- **Practice address:** 9775 SW WILSHIRE ST, SUITE 250, PORTLAND, OR 97225-5020
- **Practice address phone:** (503) 688-5187
- **Practice address fax:** (503) 688-5199
- **Mailing address:** 9775 SW WILSHIRE ST, SUITE 250, PORTLAND, OR 97225-5020
- **Mailing address phone:** (503) 688-5187
- **Mailing address fax:** (503) 688-5199

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/17/2010
- **Last updated:** 10/18/2022