Phantom Surgical Services, LLC
NPI #1134771074 in Lake Oswego, Oregon
Provider Information
- NPI Number
- 1134771074
- Entity Type
- Organization
- Organization Name
- Phantom Surgical Services, LLC
- Primary Specialty
- Physician Assistant
- Enumeration Date
- Jul 11, 2019
- Last Updated
- Jul 11, 2019
Practice Location
- Address
- 333 S STATE ST. SUITE V216
- City
- Lake Oswego
- State
- Oregon
- ZIP Code
- 97034-3948
- Phone
- (971) 256-3556
Authorized Official
- Name
- BRENDA THIELE
- Title
- MDMS NPI COMPLIANCE OFFICER
- Phone
- (210) 598-2800
Specialties & Taxonomy Codes
| Specialty |
|---|
| Physician Assistant |
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