Healthcare Provider Details

I. General information

NPI: 1255583258
Provider Name (Legal Business Name): URGENTCARE NW - FAIRVIEW PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 08/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22262 NE GLISAN ST
GRESHAM OR
97030-8553
US

IV. Provider business mailing address

PO BOX 647
GRESHAM OR
97030-0167
US

V. Phone/Fax

Practice location:
  • Phone: 503-666-5050
  • Fax: 503-666-7410
Mailing address:
  • Phone: 503-666-5050
  • Fax: 503-666-7410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MELISSA L JARCHOW
Title or Position: BILLING LEAD
Credential:
Phone: 503-666-5050