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6700 Sw 105th Ave Ste 215 Beaverton OR 97008-8824 | |
| (971) 233-6052 | |
| (971) 277-7291 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 6700 Sw 105th Ave Ste 215, Beaverton, Oregon |
| Authorized Official Name and Position | Erin Shimp (OFFICE MANAGER) |
| Authorized Official Contact | 9713990415 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
6700 Sw 105th Ave Ste 215 Beaverton OR 97008-8824 Ph: (503) 461-3910 | 6700 Sw 105th Ave Ste 215 Beaverton OR 97008-8824 Ph: (971) 233-6052 |
| NPI Number | 1912577305 |
|---|---|
| Provider Enumeration Date | 06/28/2021 |
| Last Update Date | 01/08/2025 |
| Certification Date | 01/08/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912577305 | NPI | - | NPPES |
| 500794949 | Medicaid | OR |
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