Healthcare Provider Details

I. General information

NPI: 1174580567
Provider Name (Legal Business Name): OREGON REHABILITATION MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 NE HOYT ST STE 353
PORTLAND OR
97213-2991
US

IV. Provider business mailing address

PO BOX 821350
VANCOUVER WA
98682-0030
US

V. Phone/Fax

Practice location:
  • Phone: 503-230-2833
  • Fax: 503-232-8223
Mailing address:
  • Phone: 360-687-5221
  • Fax: 360-666-0466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER PHILLIPS
Title or Position: BILLING MANAGER
Credential: CPC
Phone: 360-667-3047