| Organization Name: | STARK STREET PLAZA, LLC |
| NPI Number: | 1003914243 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHAMMAI ROCKOVE (MEDICAL DIRECTOR) |
| Mailing Address: | 24076 Se Stark St Suite 310 Gresham |
| State: | OR US |
| Postal Code: | 970303373 |
| Phone Number: | 5034926510 |
| Fax Number: | 5034926502 |
| NPI Enumeration Date: | 09/20/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |