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NPI Code Detail

MEDICARE: ORCHID OAKRIDGE CLINIC, PC

MEDICARE: ORCHID OAKRIDGE CLINIC, PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM1300XMulti-Specialty Clinic/Center
2261QR1300XRural Health Clinic/Center
3207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417098773
Entity Type Code : Organization
Provider Name (Legal Business Name) : ORCHID OAKRIDGE CLINIC, PC
Provider Business Mailing Address
First Line : PO BOX 546
Second Line :
City : GRESHAM
State : OR
Zip : 97030-0132
Country : US
Telephone Number : 503-782-8242
Fax Number : 503-862-5060
Provider Business Practice Location Address
First Line : 37400 BELL ST
Second Line :
City : SANDY
State : OR
Zip : 97055-7868
Country : US
Telephone Number : 971-220-2701
Fax Number :
Authorized Official
Title or Position : CREDENTIALING COORDINATOR
Name : ARIANA LEE
Credential :
Telephone Number : 971-373-4165
Provider Enumeration Date : 02/09/2007
Last Update Date : 02/21/2025

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