Lake Medical Clinic, Inc.

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

12913 Issued in OR

Legal business name

LAKE MEDICAL CLINIC, INC.

Practice address

550 3Rd St
Lake Oswego, OR 97034-3002

Phone

(503) 635-5044

Fax

(503) 635-3255

NPI assigned

Sep 23, 2006

Organization subpart

No

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

Authorized official

Name

Edward E Conrad Jr., MD

Title

Vice President

Phone

(503) 635-5044

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1158969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1871693564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 365",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970340042",
            "telephone_number": "503-635-5044",
            "fax_number": "503-635-3255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 3RD ST",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970343002",
            "telephone_number": "503-635-5044",
            "fax_number": "503-635-3255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE MEDICAL CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CONRAD",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "503-635-5044",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "OR",
            "license": "12913",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Lake Grove Wellness
• Lake Oswego Chiropractic Clinic, P.C.
• Lake Oswego Dermatology Group, PC
• Lake Oswego Family Physicians
• Lake Oswego Foot Clinic
• Lake Oswego Health Center

• Medical Specialty Clinic/Center in Lake Oswego, OR
• Providers in Lake Oswego, OR by specialty
• Medical Specialty Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.