# AMBULATORY SURGICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Aesthetic Breast and Cosmetic Surgery Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710992680
- **Authorized official:** DR. RONALD V DEMARS MD (ADMINISTRATOR)
- **Authorized official phone:** (503) 253-3458

## Contact information

- **Practice address:** 10201 SE MAIN ST STE 20, PORTLAND, OR 97216-2937
- **Practice address phone:** (503) 253-3458
- **Practice address fax:** (503) 253-0856
- **Mailing address:** 10201 SE MAIN ST STE 20, PORTLAND, OR 97216-2937
- **Mailing address phone:** (503) 253-3458
- **Mailing address fax:** (503) 253-0856

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 071438 | OR | Yes |

## Other

- **Enumeration date:** 07/29/2006
- **Last updated:** 06/13/2008