Healthcare Provider Details

I. General information

NPI: 1679711881
Provider Name (Legal Business Name): MCCLANEN CLEMONS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 01/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 SE KING RD
MILWAUKIE OR
97222-2538
US

IV. Provider business mailing address

6501 SE KING RD
MILWAUKIE OR
97222-2538
US

V. Phone/Fax

Practice location:
  • Phone: 503-256-4895
  • Fax: 503-788-8020
Mailing address:
  • Phone: 503-256-4895
  • Fax: 503-788-8020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number1508
License Number StateOR

VIII. Authorized Official

Name: DR. MEREDITH COLLEEN MCCLANEN
Title or Position: PRESIDENT
Credential: N.D.
Phone: 503-256-4895