| |
7632 Sw Durham Rd Ste 105 Tigard OR 97224-7597 | |
(844) 744-2200 | |
(971) 224-2506 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 7632 Sw Durham Rd Ste 105, Tigard, Oregon |
Authorized Official Name and Position | Karl Miller (OWNER) |
Authorized Official Contact | 9712242836 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
7632 Sw Durham Rd Ste 105 Tigard OR 97224-7597 Ph: (844) 744-2200 | 7632 Sw Durham Rd Ste 105 Tigard OR 97224-7597 Ph: (844) 744-2200 |
NPI Number | 1255760070 |
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Provider Enumeration Date | 11/02/2013 |
Last Update Date | 08/23/2023 |
Medicare PECOS PAC ID | 4486876240 |
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Medicare Enrollment ID | O20141111000592 |
Identifier | Type | State | Issuer |
---|---|---|---|
1255760070 | NPI | - | NPPES |
500670762 | Medicaid | OR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
Provider Name | Eliza Oh |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1518041763 PECOS PAC ID: 5991608846 Enrollment ID: I20040129000198 |
Provider Name | Toni J Feist |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1780660589 PECOS PAC ID: 3375560758 Enrollment ID: I20051025000675 |
Provider Name | Mohammed Tarek Nashawi |
---|---|
Provider Type | Practitioner - Hospitalist |
Provider Identifiers | NPI Number: 1205862505 PECOS PAC ID: 0648275339 Enrollment ID: I20061003000028 |
Provider Name | Deona J Kasten-stubbs |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1023202314 PECOS PAC ID: 4183712789 Enrollment ID: I20090115000092 |
Provider Name | Carma J Lee |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1649234527 PECOS PAC ID: 8426173568 Enrollment ID: I20100914000250 |
Provider Name | Colleen M Grimes |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1639473176 PECOS PAC ID: 2163600818 Enrollment ID: I20110628000194 |
Provider Name | Eriko Onishi |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1538261573 PECOS PAC ID: 4688636640 Enrollment ID: I20111026000958 |
Provider Name | Mckenzie L Myers |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1568869279 PECOS PAC ID: 1658545355 Enrollment ID: I20150321000070 |
Provider Name | Mary Kofstad |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1104086065 PECOS PAC ID: 6800962614 Enrollment ID: I20150831001289 |
Provider Name | Denise M Viss |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1477927606 PECOS PAC ID: 8729380290 Enrollment ID: I20151230002036 |
Provider Name | Donna L. Beeson |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1689630436 PECOS PAC ID: 2860469814 Enrollment ID: I20180309001410 |
Provider Name | Nelda J Ogden |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1023439940 PECOS PAC ID: 4486909454 Enrollment ID: I20180614001960 |
Provider Name | Heather Sanders |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1205307881 PECOS PAC ID: 9032446422 Enrollment ID: I20190807003515 |
Provider Name | Erin Hanlon Genereux |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1043899875 PECOS PAC ID: 5294124509 Enrollment ID: I20211108000892 |
Provider Name | Christina Cyrway |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1750944484 PECOS PAC ID: 3072949353 Enrollment ID: I20211130000300 |
Provider Name | Allison Beaman |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1972264075 PECOS PAC ID: 5496149981 Enrollment ID: I20220226000364 |
Provider Name | Jeanette Hazel Marie Reiners |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1609418722 PECOS PAC ID: 8022443381 Enrollment ID: I20220825001489 |
Provider Name | Ingrid Theresia Passier |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1326783184 PECOS PAC ID: 7416332192 Enrollment ID: I20220915003442 |
Provider Name | Amethyst White |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1356052344 PECOS PAC ID: 8729440375 Enrollment ID: I20230814001654 |
Provider Name | Dana Sheehan |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1952780058 PECOS PAC ID: 6103136098 Enrollment ID: I20240319003708 |
Provider Name | Graceful Iris Morris |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1114759578 PECOS PAC ID: 5698215267 Enrollment ID: I20240919001209 |
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