Organization
EAST PORTLAND SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC BOON (MARKET PRESIDENT)
(480) 567-0269
Entity
Organization
Contact information
Practice address
9200 SE 91ST AVE, SUITE 100, HAPPY VALLEY, OR 97086-3756
(503) 772-6160
(503) 772-6161
Mailing address
14201 DALLAS PKWY, DALLAS, TX 75254-2916
(469) 893-2500
(504) 322-3284
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
07-1604
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500624087
—
OR
01
—
P00864506
RAILROAD MEDICARE
OR
Enumeration date
12/31/2009
Last updated
09/19/2024
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