Healthcare Provider Details

I. General information

NPI: 1770147357
Provider Name (Legal Business Name): UPTOWN PROVIDERS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

397 WARNER MILNE RD
OREGON CITY OR
97045-4045
US

IV. Provider business mailing address

8060 SW PFAFFLE ST STE 106
TIGARD OR
97223-8489
US

V. Phone/Fax

Practice location:
  • Phone: 503-305-6262
  • Fax: 877-991-8038
Mailing address:
  • Phone: 971-233-0435
  • Fax: 877-991-8038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

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