1013305184 NPI number — LAURA GOFF ACUPUNCTURE, LLC

Table of content: (NPI 1013305184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013305184 NPI number — LAURA GOFF ACUPUNCTURE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAURA GOFF ACUPUNCTURE, LLC
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:
1013305184
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1744 SE NEHALEM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97202-6734
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-730-7749
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7048 SE MILWAUKIE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97202-5719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-730-7749
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/24/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GOFF
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
AMROFELL
Authorized Official Title or Position:
OWNER/ACUPUNCTURIST
Authorized Official Telephone Number:
503-730-7749

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC01241 , 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)