Maple Street Clinic, PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MAPLE STREET CLINIC, PC

Practice address

1825 Maple St
Forest Grove, OR 97116-1939

Phone

(503) 357-2136

Fax

(503) 359-5479

NPI assigned

Jun 29, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. John Dahlquist

Title

Clinic Administrator

Phone

(503) 357-2136

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357776000000",
    "number": "1225066194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1825 MAPLE ST",
            "city": "FOREST GROVE",
            "state": "OR",
            "postal_code": "971161939",
            "telephone_number": "503-357-2136",
            "fax_number": "503-359-5479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 MAPLE ST",
            "city": "FOREST GROVE",
            "state": "OR",
            "postal_code": "971161939",
            "telephone_number": "503-357-2136",
            "fax_number": "503-359-5479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE STREET CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-29",
        "last_updated": "2013-01-10",
        "status": "A",
        "authorized_official_last_name": "DAHLQUIST",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "503-357-2136",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTIN",
            "identifier": "R0000WCBCC",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christine June Ma
• Mandy Mie Yu Mah
• Managed Health Care of Oregon I LLC (Managed Healthcare of Or LLC)
• Cristina Leigh Mandera, LMT
• Maple Street Clinic Pharmacy LLC (Maple Street Clinic Pharmacy)
• Noah Marek, PT
• Marilyn J Booth MD
• Marquis Companies II, Inc (Marquis Forest Grove Assisted Living)
• Marquis Companies II, Inc. (Marquis Forest Grove Post Acute Rehab)
• Jennifer Renae Martens, DC, LMT

• Family Medicine Physician in Forest Grove, OR
• Providers in Forest Grove, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.