Provider Demographics
NPI:1679902720
Name:LOVEJOY SURGICENTER INC
Entity type:Organization
Organization Name:LOVEJOY SURGICENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:KLASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-340-2995
Mailing Address - Street 1:933 NW 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2829
Mailing Address - Country:US
Mailing Address - Phone:503-221-1870
Mailing Address - Fax:503-221-1488
Practice Address - Street 1:933 NW 25TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2829
Practice Address - Country:US
Practice Address - Phone:503-221-1870
Practice Address - Fax:503-221-1488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR07-0978261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR187153Medicaid