Provider Demographics
NPI:1366820888
Name:BENCHMARK CLINIC OF INTEGRATIVE MEDICINE, PC
Entity type:Organization
Organization Name:BENCHMARK CLINIC OF INTEGRATIVE MEDICINE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:SAUTER
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:502-223-7067
Mailing Address - Street 1:2456 NW NORTHRUP ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3253
Mailing Address - Country:US
Mailing Address - Phone:503-223-7067
Mailing Address - Fax:503-223-9639
Practice Address - Street 1:2456 NW NORTHRUP ST
Practice Address - Street 2:1A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3253
Practice Address - Country:US
Practice Address - Phone:503-223-7067
Practice Address - Fax:503-223-9639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-16
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00112171100000X
OR18005261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty