Organization
PORTLAND ORTHOPEDIC SERVICES P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM WALLACE TILSON C.O. (OWNER/PRESIDENT)
(503) 408-8378
Entity
Organization
Contact information
Practice address
12037 NE MARX ST, PORTLAND, OR 97220-9013
(503) 408-8378
(503) 408-8389
Mailing address
12037 NE MARX ST, PORTLAND, OR 97220-9013
(503) 408-8378
(503) 408-8389
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
230829
—
OR
Enumeration date
06/30/2006
Last updated
08/22/2020
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