Oregon Cosmetic and Reconstructive Clinic, PC

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

Legal business name

OREGON COSMETIC AND RECONSTRUCTIVE CLINIC, PC

Practice address

10202 SE 32ND Ave
Suite 702
Milwaukie, OR 97222-3610

Phone

(503) 400-6622

Fax

(503) 400-6622

NPI assigned

Jun 18, 2010

Last updated

Sep 22, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tina Jenq, MDNPI 1730346388

Title

Owner

Phone

(503) 400-6622

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tina Jenq, MD

  • Plastic Surgery Physician
  • Portland, OR
  • NPI 1730346388
  Medicare reassignment NPD Authorized official
• John Stephen Domreis, M.D.

  • Surgery Physician
  • Oregon City, OR
  • NPI 1629168646
  NPD (past)
• Tyler Scott Mittelstaedt, MD-MPH

  • Surgery Physician
  • Oregon City, OR
  • NPI 1053678284
  NPD (past)
• Haruka Swendsen Snow, MD

  • Surgery Physician
  • Oregon City, OR
  • NPI 1891119947
  NPD (past)

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

{
    "created_epoch": "1276819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285113600000",
    "number": "1407177934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 66500",
            "address_2": "PO",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972906500",
            "telephone_number": "503-657-8663",
            "fax_number": "503-723-3180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10202 SE 32ND AVE",
            "address_2": "SUITE 702",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972223610",
            "telephone_number": "503-400-6622",
            "fax_number": "503-400-6622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OREGON COSMETIC AND RECONSTRUCTIVE CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-18",
        "last_updated": "2010-09-22",
        "status": "A",
        "authorized_official_last_name": "JENQ",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-400-6622",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deanna K Olson, MD
• Oralee Olson, RDH
• Daniel Oneill, L.AC.
• David Ong
• Mihai Daniel Onofrei, PHARMD.
• Oregon Trail Recovery
• Oregon Trail Recovery LLC
• Joycelyn Oribello, PHYSICAL THERAPIST A
• Perla Carolina Orozco Barajas
• Kyra Ortega-Schwartz, CHW

• Plastic Surgery Physician in Milwaukie, OR
• Providers in Milwaukie, OR by specialty
• Plastic Surgery Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.