Provider Demographics
NPI:1023582178
Name:PEACEHEALTH NETWORKS ON DEMAND, LLC
Entity type:Organization
Organization Name:PEACEHEALTH NETWORKS ON DEMAND, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:CRANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-684-8252
Mailing Address - Street 1:11958 SW GARDEN PL
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8248
Mailing Address - Country:US
Mailing Address - Phone:503-684-8252
Mailing Address - Fax:866-859-8195
Practice Address - Street 1:11958 SW GARDEN PL
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8248
Practice Address - Country:US
Practice Address - Phone:503-684-8252
Practice Address - Fax:866-859-8195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-11
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty