Healthcare Provider Details

I. General information

NPI: 1114435641
Provider Name (Legal Business Name): MICHAEL SEAN PARTRIDGE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 SW 2ND CT
GRESHAM OR
97080-6760
US

IV. Provider business mailing address

2008 SW 2ND CT
GRESHAM OR
97080-6760
US

V. Phone/Fax

Practice location:
  • Phone: 503-267-8171
  • Fax:
Mailing address:
  • Phone: 503-267-8171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: