Goldstar Vascular Access, Inc

Primary specialty

Nursing Care AgencyTaxonomy code 251J00000X

Legal business name

GOLDSTAR VASCULAR ACCESS, INC

Practice address

2870 NE Hogan Dr
Ste E #205
Gresham, OR 97030

Phone

(150) 351-6920

NPI assigned

Jun 20, 2017

Organization subpart

No

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

Authorized official

Name

Mr. David Ilnitskiy, RN

Title

President

Phone

(503) 516-9205

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1497916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1497916800000",
    "number": "1225568454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1871 SE IRONWOOD WAY",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970803002",
            "telephone_number": "15035169205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2870 NE HOGAN DR",
            "address_2": "STE E #205",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "97030",
            "telephone_number": "150-351-6920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDSTAR VASCULAR ACCESS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-20",
        "last_updated": "2017-06-20",
        "status": "A",
        "authorized_official_last_name": "ILNITSKIY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-516-9205",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nursing Care Agency in Gresham, OR
• Providers in Gresham, OR by specialty
• Nursing Care Agency in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2017; 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.