Healthcare Provider Details

I. General information

NPI: 1336128321
Provider Name (Legal Business Name): URGENT CARE NW GRESHAM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 SE POWELL VALLEY RD
GRESHAM OR
97080
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 NumberMD14769
License Number StateOR

VIII. Authorized Official

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