Stark Street Plaza, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

STARK STREET PLAZA, LLC

Practice address

24076 SE Stark St
Suite 310
Gresham, OR 97030-3373

Phone

(503) 492-6510

Fax

(503) 492-6502

NPI assigned

Sep 20, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Shammai Rockove, M.D.

Title

Medical Director

Phone

(503) 492-6510

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003914243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24076 SE STARK ST",
            "address_2": "SUITE 310",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970303373",
            "telephone_number": "503-492-6510",
            "fax_number": "503-492-6502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24076 SE STARK ST",
            "address_2": "SUITE 310",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970303373",
            "telephone_number": "503-492-6510",
            "fax_number": "503-492-6502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STARK STREET PLAZA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROCKOVE",
        "authorized_official_first_name": "SHAMMAI",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "503-492-6510",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ana M Squellati, ND
• Christopher Stadnick, MD
• Salomeia Stan, L.M.T.
• Teagan Wyn Stanley
• Laquita Stansbury
• Emily Anderson Steele
• Shannon Steele
• Katie Anne Steinke, D.C
• Rebekah Steltzer, LMP
• Stephen K. Choong, MD PC

• Ambulatory Surgical Clinic/Center in Gresham, OR
• Providers in Gresham, OR by specialty
• Ambulatory Surgical Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.