Fanno Creek Clinic Llc

LBN: Fanno Creek Clinic Llc
Fanno Creek Clinic Llc is an health care organization with primary practice located at 2400 Sw Vermont St , Portland OR 97219-1940. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as the primary health care specialty. Fanno Creek Clinic Llc can be contacted via phone (503) 452-0915, or through Reed, Larry M via phone (503) 452-0915.

Contact Information

Primary practice address
2400 Sw Vermont St Portland OR 97219-1940
Phone: (503) 452-0915
Fax: (503) 768-9232
Website:
Map and Directions
Authorized official contact:
Name: Reed, Larry M
Phone: (503) 452-0915

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 2802 Oregon

Profile Details

NPI number 1609876705
LBN Legal business name Fanno Creek Clinic Llc
DBA Doing business as
Authorized official Reed, Larry M
Entity Organization
Organization subpart 1 No
Enumeration date Jul 29th, 2005
Last updated Oct 16th, 2007 - about 19 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1609876705 NPPES
Oregon MEDICAID 151070

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