Eleven Eleven, LLC

Primary specialty

Medical Art Specialist/TechnologistTaxonomy code 246ZA2600X

License

BAP-TA-10133461 Issued in OR

Legal business name

ELEVEN ELEVEN, LLC

Practice address

6714 SW 62ND Place
Portland, OR 97219

Phone

(503) 956-9773

NPI assigned

Dec 1, 2014

Last updated

Dec 1, 2014By 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

Mr. Erik Berntsen

Title

Owner

Phone

(503) 956-9773

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1417392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417392000000",
    "number": "1548667918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6714 SW 62ND PLACE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97219",
            "telephone_number": "503-956-9773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6714 SW 62ND PLACE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97219",
            "telephone_number": "503-956-9773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELEVEN ELEVEN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-01",
        "last_updated": "2014-12-01",
        "status": "A",
        "authorized_official_last_name": "BERNTSEN",
        "authorized_official_first_name": "ERIK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-956-9773",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "246ZA2600X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Other, Art, Medical",
            "state": "OR",
            "license": "BAP-TA-10133461",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Medical Art Specialist/Technologist in Portland, OR
• Providers in Portland, OR by specialty
• Medical Art Specialist/Technologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2014; 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.