FMG Northeast Weidler Street Oregon LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

FMG NORTHEAST WEIDLER STREET OREGON LLC

Practice address

11325 NE Weidler St
Portland, OR 97220-1950

Phone

(503) 253-1181

Fax

(503) 253-1871

NPI assigned

Dec 24, 2014

Organization subpart

No

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

Authorized official

Name

David C. Keating

Title

Agent

Phone

(414) 908-8058

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1419379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510012800000",
    "number": "1710375878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5001 WEST LEMON STREET",
            "address_2": "C/O FOCUS MANAGEMENT GROUP",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336091103",
            "telephone_number": "813-281-0062",
            "fax_number": "813-281-0063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11325 NE WEIDLER ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972201950",
            "telephone_number": "503-253-1181",
            "fax_number": "503-253-1871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FMG NORTHEAST WEIDLER STREET OREGON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-24",
        "last_updated": "2017-11-07",
        "status": "A",
        "authorized_official_last_name": "KEATING",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "AGENT",
        "authorized_official_telephone_number": "414-908-8058"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Mary Flynn, MD
• Michael Joseph Flynn, MS
• Patricia Lamb Flynn, MSW, LCSW
• Thomas Francis Flynn, MD
• Tracy Flynn
• Crystal Seulin Fo, M.D.
• Raissa Bibiana Fobi Ngebi, M.D.
• Aloysius N. Fobi, MD
• Laura Beth Fockler, PHARM.D.
• Susan Ann Fodell, CCC-SLP

• Skilled Nursing Facility in Portland, OR
• Providers in Portland, OR by specialty
• Skilled Nursing Facility in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2017; 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.