Healthcare Provider Details

I. General information

NPI: 1316249394
Provider Name (Legal Business Name): UPTOWN PROVIDERS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2010
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17437 BOONES FERRY RD STE 100
LAKE OSWEGO OR
97035-6201
US

IV. Provider business mailing address

17437 BOONES FERRY RD STE 100
LAKE OSWEGO OR
97035-6201
US

V. Phone/Fax

Practice location:
  • Phone: 503-305-6262
  • Fax: 503-305-6078
Mailing address:
  • Phone: 503-305-6262
  • Fax: 503-305-6078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GURU SANKAR
Title or Position: CENTER DIRECTOR
Credential:
Phone: 503-744-0399