Provider Demographics
NPI:1700903085
Name:OAK STREET SURGICAL ASSOCIATES PC
Entity type:Organization
Organization Name:OAK STREET SURGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-364-6843
Mailing Address - Street 1:875 OAK ST SE
Mailing Address - Street 2:#4010
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301
Mailing Address - Country:US
Mailing Address - Phone:503-364-6843
Mailing Address - Fax:503-585-5273
Practice Address - Street 1:875 OAK ST SE
Practice Address - Street 2:#4010
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:503-364-6843
Practice Address - Fax:503-585-5273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000WFBDWMedicare ID - Type Unspecified