Healthcare Provider Details

I. General information

NPI: 1265417174
Provider Name (Legal Business Name): THE OREGON CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 NE 20TH AVE SUITE 225
PORTLAND OR
97232
US

IV. Provider business mailing address

PO BOX 5277
PORTLAND OR
97208-5277
US

V. Phone/Fax

Practice location:
  • Phone: 503-963-2801
  • Fax: 503-963-2825
Mailing address:
  • Phone: 503-963-2801
  • Fax: 503-963-2825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number160412
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number160412
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number160412
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number160412
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number160412
License Number StateOR

VIII. Authorized Official

Name: RICHARD JAMISON
Title or Position: PRESIDENT
Credential:
Phone: 503-963-2801