Basic Information
| Provider Information | |||||||||
| NPI: | 1104993286 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SILVERTON SURGICAL,LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 450 WELCH ST | ||||||||
| Address2: | |||||||||
| City: | SILVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973811934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038735310 | ||||||||
| FaxNumber: | 5038735315 | ||||||||
| Practice Location | |||||||||
| Address1: | 450 WELCH ST | ||||||||
| Address2: | |||||||||
| City: | SILVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973811934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038735310 | ||||||||
| FaxNumber: | 5038735315 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 09/21/2010 | ||||||||
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| AuthorizedOfficialLastName: | WATERS | ||||||||
| AuthorizedOfficialFirstName: | HARRIS | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5038735310 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | OR | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.