# PORTLAND CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PORTLAND CLINIC
- **Other names:** Roger E. Alberty, M.D. Surgical Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1508040486
- **Legal business name:** PORTLAND CLINIC
- **Authorized official:** MR. DICK CLARK (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (503) 221-0161

## Contact information

- **Practice address:** 9100 SW OLESON ROAD, TIGARD, OR 97223
- **Practice address phone:** (503) 445-9066
- **Mailing address:** 800 SW 13TH AVE, PORTLAND, OR 97205-1902
- **Mailing address phone:** (503) 221-0161
- **Mailing address fax:** (503) 221-4451

## Taxonomy

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

## Other

- **Enumeration date:** 12/27/2007
- **Last updated:** 10/26/2020