NPIMap

Organization Active NPI

Proactive Health Resources, LLC

  • Clinical Medical Laboratory
  • Lake Oswego, OR
National Provider Identifier
1346492964
Registry record updated Oct 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
9142 Issued in OR
Legal business name
PROACTIVE HEALTH RESOURCES, LLC
Practice address
4077 Jefferson Pkwy
Lake Oswego, OR 97035-1478
Phone
(503) 342-6202
NPI assigned
Oct 14, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2008

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

Authorized official

Name
Ms. Phyllis Vanderveer, RN
Title
President/Owner
Phone
(503) 342-6202

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 9142 OR Primary

Addresses

Primary practice location

4077 Jefferson Pkwy
Lake Oswego, OR 97035-1478

Mailing address

4077 Jefferson Pkwy
Lake Oswego, OR 97035-1478
Phone (503) 342-6202

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1223942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223942400000",
    "number": "1346492964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4077 JEFFERSON PKWY",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970351478",
            "telephone_number": "503-342-6202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4077 JEFFERSON PKWY",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970351478",
            "telephone_number": "503-342-6202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROACTIVE HEALTH RESOURCES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-14",
        "last_updated": "2008-10-14",
        "status": "A",
        "authorized_official_last_name": "VANDERVEER",
        "authorized_official_first_name": "PHYLLIS",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "503-342-6202",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "OR",
            "license": "9142",
            "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 Oct 14, 2008; 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.