Healthcare Provider Details

I. General information

NPI: 1205499126
Provider Name (Legal Business Name): EXPRESS CARE OR PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 NW 14TH AVE
PORTLAND OR
97209-2705
US

IV. Provider business mailing address

PO BOX 3229
PORTLAND OR
97208-3229
US

V. Phone/Fax

Practice location:
  • Phone: 888-327-3312
  • Fax:
Mailing address:
  • Phone: 888-227-3312
  • Fax: 425-276-3215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DONALD WAYNE ANDERSON JR.
Title or Position: ASSISTANT SECRETARY OF ENROLLMENTS
Credential:
Phone: 425-358-9786