Basic Information
| Provider Information | |||||||||
| NPI: | 1386730026 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STARR-WOOD CARDIAC GROUP OF PORTLAND PC | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | NORTHSTARR CARDIOTHORACIC SURGERY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9135 SW BARNES RD STE 963 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972256699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032971419 | ||||||||
| FaxNumber: | 5032162488 | ||||||||
| Practice Location | |||||||||
| Address1: | 9135 SW BARNES RD STE 963 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972256699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032971419 | ||||||||
| FaxNumber: | 5032162488 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 01/21/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | FLOTEN | ||||||||
| AuthorizedOfficialFirstName: | H | ||||||||
| AuthorizedOfficialMiddleName: | STORM | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5032971419 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 01/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.