Organization
NORTHWEST AMBULATORY SURGERY CENTER LLC
Active
Other names
Northwest Ambulatory Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC BOON (OFFICER/AUTHORIZED OFFICIAL)
(480) 567-0269
Entity
Organization
Contact information
Practice address
1515 NW 18TH AVE, STE 200, PORTLAND, OR 97209-2516
(503) 542-4888
(503) 542-2813
Mailing address
14201 DALLAS PKWY, DALLAS, TX 75254-2916
(503) 542-4888
(503) 542-2813
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
07 1564
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00722196
RAILROAD MEDICARE
OR
Enumeration date
10/22/2008
Last updated
10/14/2024
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