1841843778 NPI number — PACIFIC CLINIC OF NATURAL MEDICINE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841843778 NPI number — PACIFIC CLINIC OF NATURAL MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFIC CLINIC OF NATURAL MEDICINE
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:
TRULY NATURAL MEDICINE
Provider Other Organization Name Type Code:
4
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:
1841843778
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
511 SW 10TH AVE STE 707
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:
97205-2708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-894-8977
Provider Business Mailing Address Fax Number:
833-551-4832

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
511 SW 10TH AVE STE 1107
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:
97205-2712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
971-279-7260
Provider Business Practice Location Address Fax Number:
833-551-4832
Provider Enumeration Date:
07/19/2019

Additional Information

Authorized Official

Authorized Official Last Name:
TRUE
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
503-894-8977

Provider Taxonomy Codes

  • Taxonomy code: 171100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 175F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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