Organization
NGC ENDOSCOPY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROLAND WILLIAM BENNETTS (MEDICAL DIRECTOR)
(503) 229-7137
Entity
Organization
Contact information
Practice address
1130 NW 22ND AVE STE 410, PORTLAND, OR 97210-2911
(503) 229-7137
Mailing address
1130 NW 22ND AVE STE 615, PORTLAND, OR 97210-2977
(503) 229-7137
(503) 241-0628
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
07 1539
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100355
—
OR
Enumeration date
11/01/2006
Last updated
08/22/2020
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