1871745570 NPI number — CHEHALEM VALLEY FOOT CLINIC, PC

Table of content: (NPI 1871745570)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871745570 NPI number — CHEHALEM VALLEY FOOT CLINIC, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHEHALEM VALLEY FOOT CLINIC, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871745570
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 N WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWBERG
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97132-2727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-538-0800
Provider Business Mailing Address Fax Number:
503-554-8408

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 N WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWBERG
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97132-2727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-538-0800
Provider Business Practice Location Address Fax Number:
503-554-8408
Provider Enumeration Date:
10/14/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LIPE
Authorized Official First Name:
LISA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
503-538-0800

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  DP00180 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)