Provider Demographics
NPI:1760820542
Name:3RD HAND SURGICAL ASSIST LLC
Entity type:Organization
Organization Name:3RD HAND SURGICAL ASSIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:503-860-0619
Mailing Address - Street 1:3600 SW 93RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-2815
Mailing Address - Country:US
Mailing Address - Phone:503-860-0619
Mailing Address - Fax:503-297-2649
Practice Address - Street 1:3600 SW 93RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-2815
Practice Address - Country:US
Practice Address - Phone:503-860-0619
Practice Address - Fax:503-297-2649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00508363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty