NPIMap

Organization Active NPI

Mt. Tabor Family Medical Group, P.C.

  • Non-Pharmacy Dispensing Site
  • Portland, OR
National Provider Identifier
1548416944
Registry record updated Jul 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
MD12668 Issued in OR
Legal business name
MT. TABOR FAMILY MEDICAL GROUP, P.C.
Practice address
5919 SE Belmont St
Portland, OR 97215-1925
Phone
(503) 234-7366
NPI assigned
Aug 18, 2008
Organization subpart
Yes
Parent organization
MEDVANTX, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 2, 2010

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

Authorized official

Name
Kenny Heine
Title
Director of Operations
Phone
(858) 625-2990

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X MD12668 OR Primary

Addresses

Primary practice location

5919 SE Belmont St
Portland, OR 97215-1925

Mailing address

5810 Nancy Ridge Dr
100
San Diego, CA 92121-2834

National Provider Directory

National Provider Directory
Part of
Tri - State Medical Group Inc

Practitioners & affiliated clinicians

Practitioners 11

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": "1219017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278028800000",
    "number": "1548416944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5810 NANCY RIDGE DR",
            "address_2": "100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5919 SE BELMONT ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972151925",
            "telephone_number": "503-234-7366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT. TABOR FAMILY MEDICAL GROUP, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2008-08-18",
        "last_updated": "2010-07-02",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "OR",
            "license": "MD12668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2010; 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.