NPIMap

Organization Active NPI

The Medical Wellness Clinic, LLC

  • Internal Medicine Physician
  • Lake Oswego, OR
National Provider Identifier
1295922755
Registry record updated Sep 28, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD07794 Issued in OR
Legal business name
THE MEDICAL WELLNESS CLINIC, LLC
Practice address
4035 Mercantile Dr
Suite 101
Lake Oswego, OR 97035-2546
Phone
(503) 697-3001
Fax
(503) 697-0906
NPI assigned
Sep 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2007

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

Authorized official

Name
Stephen A Weil, MDNPI 1447201215
Title
Clinic Director
Phone
(503) 697-3001

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X MD07794 OR Primary

Addresses

Primary practice location

4035 Mercantile Dr
Suite 101
Lake Oswego, OR 97035-2546

Mailing address

4035 Mercantile Dr
Suite 101
Lake Oswego, OR 97035-2546
Phone (503) 697-3001

National Provider Directory

National Provider Directory

Locations

4035 Mercantile Dr
#101
Lake Oswego, OR 97035
Phone (503) 697-3001

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1190937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190937600000",
    "number": "1295922755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4035 MERCANTILE DR",
            "address_2": "SUITE 101",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970352546",
            "telephone_number": "503-697-3001",
            "fax_number": "503-697-0906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4035 MERCANTILE DR",
            "address_2": "SUITE 101",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970352546",
            "telephone_number": "503-697-3001",
            "fax_number": "503-697-0906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE MEDICAL WELLNESS CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-28",
        "last_updated": "2007-09-28",
        "status": "A",
        "authorized_official_last_name": "WEIL",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "503-697-3001",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD07794",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Oswego, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2007; 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.