NPIMap

Organization Active NPI

Wildwood Family Medicine, LLC

  • Primary Care Clinic/Center
  • Portland, OR
National Provider Identifier
1952718579
Registry record updated Jul 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
1974 Issued in OR
Legal business name
WILDWOOD FAMILY MEDICINE, LLC
Practice address
7319 N John Ave
#101
Portland, OR 97203-4885
Phone
(503) 289-3370
NPI assigned
Jul 15, 2014
Last updated
Jul 15, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2014

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

Authorized official

Name
Dr. Lisa Bryant, N.D.NPI 1447687405
Title
Owner
Phone
(360) 903-4866

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 1974 OR Primary

Addresses

Primary practice location

7319 N John Ave
#101
Portland, OR 97203-4885

Mailing address

315 W 24TH St
Vancouver, WA 98660-2528
Phone (360) 903-4866

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1405382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405382400000",
    "number": "1952718579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 W 24TH ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986602528",
            "telephone_number": "360-903-4866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7319 N JOHN AVE",
            "address_2": "#101",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972034885",
            "telephone_number": "503-289-3370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDWOOD FAMILY MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-15",
        "last_updated": "2014-07-15",
        "status": "A",
        "authorized_official_last_name": "BRYANT",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-903-4866",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "N.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "OR",
            "license": "1974",
            "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 Jul 15, 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.