Provider Demographics
NPI:1538146931
Name:WILLAMETTE SURGERY CENTER LLC
Entity type:Organization
Organization Name:WILLAMETTE SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LORISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADDABBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-566-3507
Mailing Address - Street 1:665 WINTER STREET
Mailing Address - Street 2:ATTN: CARLA REILLY
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301
Mailing Address - Country:US
Mailing Address - Phone:503-566-3507
Mailing Address - Fax:
Practice Address - Street 1:1445 STATE ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4248
Practice Address - Country:US
Practice Address - Phone:503-566-3507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR071522261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR268892Medicaid
OR268892Medicaid