NPIMap

Organization Active NPI

Mt. Tabor Family Medical Group, PC

  • Clinic/Center
  • Portland, OR
National Provider Identifier
1659468080
Registry record updated Mar 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
MT. TABOR FAMILY MEDICAL GROUP, PC
Practice address
5919 SE Belmont St
Portland, OR 97215-1925
Phone
(503) 234-7366
Fax
(503) 234-8928
NPI assigned
Oct 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2013

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

Authorized official

Name
Mrs. Lori E Nies
Title
Clinic Manager
Phone
(503) 234-7366

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

5919 SE Belmont St
Portland, OR 97215-1925

Mailing address

5919 SE Belmont St
Portland, OR 97215-1925
Phone (503) 234-7366

National Provider Directory

National Provider Directory

Locations

5919 SE Belmont St
Portland, OR 97215
Phone (503) 234-7366

Practitioners & affiliated clinicians

Practitioners 3

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": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362096000000",
    "number": "1659468080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5919 SE BELMONT ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972151925",
            "telephone_number": "503-234-7366",
            "fax_number": "503-234-8928"
        },
        {
            "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",
            "fax_number": "503-234-8928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT. TABOR FAMILY MEDICAL GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2013-03-01",
        "status": "A",
        "authorized_official_last_name": "NIES",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "503-234-7366",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "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 Mar 1, 2013; 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.