Basic Information
Provider Information
NPI: 1548267297
EntityType: 2
ReplacementNPI:  
OrganizationName: THE ENDOSCOPY CENTER AT WEST HILLS GASTROENTEROLOGY, LLC
LastName:  
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Mailing Information
Address1: 975 SE SANDY BLVD
Address2: SUITE 201
City: PORTLAND
State: OR
PostalCode: 972141308
CountryCode: US
TelephoneNumber: 5032360775
FaxNumber: 5032360786
Practice Location
Address1: 9701 SW BARNES RD
Address2: SUITE 310
City: PORTLAND
State: OR
PostalCode: 972256772
CountryCode: US
TelephoneNumber: 5032978081
FaxNumber: 5032926601
Other Information
ProviderEnumerationDate: 07/07/2005
LastUpdateDate: 08/20/2008
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: FAUSEL
AuthorizedOfficialFirstName: CRAIG
AuthorizedOfficialMiddleName: S
AuthorizedOfficialTitleorPosition: CEO/PRESIDENT
AuthorizedOfficialTelephone: 5032360775
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QA1903X  Y Ambulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical

ID Information
IDTypeStateIssuerDescription
02291705OR MEDICAID


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