Provider Demographics
NPI:1174947196
Name:OREGON CITY MEDICAL, NW
Entity type:Organization
Organization Name:OREGON CITY MEDICAL, NW
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-656-9030
Mailing Address - Street 1:800 SE 181ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-4995
Mailing Address - Country:US
Mailing Address - Phone:503-489-9500
Mailing Address - Fax:
Practice Address - Street 1:800 SE 181ST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-4995
Practice Address - Country:US
Practice Address - Phone:503-489-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty