Healthcare Provider Details

I. General information

NPI: 1215309497
Provider Name (Legal Business Name): OREGON PEDORTHIC SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10117 SE SUNNYSIDE RD SUITE H
CLACKAMAS OR
97015-7708
US

IV. Provider business mailing address

PO BOX 608
GRESHAM OR
97030-0154
US

V. Phone/Fax

Practice location:
  • Phone: 503-305-7254
  • Fax: 503-489-0706
Mailing address:
  • Phone: 503-491-1723
  • Fax: 503-489-0706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DOUG P MCCURTAIN
Title or Position: OWNER AND PRESIDENT
Credential: C.PED
Phone: 503-491-1723