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  7. NPI Record 1336705557

OREGON SPECIAL SURGERY CENTER
Complete NPI Record 1336705557
Clinic/Center - Ambulatory Surgical in Salem, OR

NPI Status: Active since May 13, 2019

Contact Information

2785 RIVER RD S
SALEM, OR
ZIP 97302
Phone: (503) 881-9459
Fax: (503) 363-4373

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider Business Mailing Address Telephone Number
  11. Provider Business Mailing Address Fax Number
  12. Provider First Line Business Practice Location Address
  13. Provider Business Practice Location Address City Name
  14. Provider Business Practice Location Address State Name
  15. Provider Business Practice Location Address Postal Code
  16. Provider Business Practice Location Address Country Code If outside U S
  17. Provider Business Practice Location Address Telephone Number
  18. Provider Business Practice Location Address Fax Number
  19. Provider Enumeration Date
  20. Last Update Date
  21. Authorized Official Last Name
  22. Authorized Official First Name
  23. Authorized Official Title or Position
  24. Authorized Official Telephone Number
  25. Healthcare Provider Taxonomy Code 1
  26. Healthcare Provider Primary Taxonomy Switch 1
  27. Other Provider Identifier 1
  28. Other Provider Identifier Type Code 1
  29. Other Provider Identifier State 1
  30. Other Provider Identifier Issuer 1
  31. Is Organization Subpart
  32. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1336705557. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1336705557
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
The date that a record was last updated or changed.
Employer Identification Number EIN: UNAVAIL
The code designating the provider’s gender if the provider is a person.
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider First Line Business Mailing Address: 2480 LIBERTY ST NE STE 180
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider Business Mailing Address City Name: SALEM
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: OR
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 973018388
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 5038819459
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 5033634373
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 2785 RIVER RD S
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: SALEM
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: OR
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 973025883
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 5038819459
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 5033634373
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 5/13/2019
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 9/1/2021
The date that a record was last updated or changed.
Authorized Official Last Name: CHEN
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: CHONTHICHA
The first name of the authorized official.
Authorized Official Title or Position: GENERAL MANAGER
The title or position of the authorized official.
Authorized Official Telephone Number: 5038819459
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 261QA1903X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: Y
Other Provider Identifier 1: 261QA1903X
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: OR
Other Provider Identifier Issuer 1: AMBULATORY SURGERY CENTER
Is Organization Subpart: N
NPI Certification Date: 9/1/2021