Healthcare Provider Details

I. General information

NPI: 1275670614
Provider Name (Legal Business Name): NEWBERG URGENT CARE AND MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 HAYES ST
NEWBERG OR
97132-1310
US

IV. Provider business mailing address

2880 HAYES ST
NEWBERG OR
97132-1310
US

V. Phone/Fax

Practice location:
  • Phone: 503-537-9600
  • Fax: 503-537-0105
Mailing address:
  • Phone: 503-537-9600
  • Fax: 503-537-0105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: AUGUSTINE GONZALES
Title or Position: ADMINISTRATOR OWNER
Credential:
Phone: 503-537-9600