Oregon City Medical NW, Inc

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

1500005833 Issued in OR

Legal business name

OREGON CITY MEDICAL NW, INC

Practice address

6464 SW Borland Road #D-4
Tualatin, OR 97062

Phone

(503) 487-3001

NPI assigned

Apr 29, 2015

Organization subpart

No

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

Authorized official

Name

Danielle Blackwell, FNP

Title

FNP/Owner

Phone

(503) 656-9030

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Tualatin Family Medicine Doing business as

Tax ID family

Beaverton Family Medicine3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Oregon City Medical

  • Primary Care Clinic/Center
  • Beaverton, OR
  • NPI 1457604654
  NPD tax ID
• Oregon City Medical, NW

  • Family Medicine Physician
  • Portland, OR
  • NPI 1174947196
  NPD tax ID

Locations

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

{
    "created_epoch": "1430265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430265600000",
    "number": "1760869739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6464 SW BORLAND ROAD #D-4",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "97062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6464 SW BORLAND ROAD #D-4",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "97062",
            "telephone_number": "503-487-3001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OREGON CITY MEDICAL NW, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-29",
        "last_updated": "2015-04-29",
        "status": "A",
        "authorized_official_last_name": "BLACKWELL",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_title_or_position": "FNP/OWNER",
        "authorized_official_telephone_number": "503-656-9030",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "OR",
            "license": "1500005833",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "218463",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "R142037",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tualatin Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Andrea C Olmstead, MD
• Kassandra Olsen, PTA, LMT
• Kevin Donald Olson, M.D.
• Oncology Physicians Network of Oregon LLC
• Or Krew, LLC
• Oregon Clinic, PC
• Oregon Department of Corrections
• Oregon Eye Specialists, PC
• Oregon Eye Specialists, PC
• Oregon Health Endocrinology

• Clinic/Center in Tualatin, OR
• Providers in Tualatin, OR by specialty
• Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2015; 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.