Healthcare Provider Details

I. General information

NPI: 1417098773
Provider Name (Legal Business Name): ORCHID OAKRIDGE CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37400 BELL ST
SANDY OR
97055-7868
US

IV. Provider business mailing address

PO BOX 546
GRESHAM OR
97030-0132
US

V. Phone/Fax

Practice location:
  • Phone: 971-220-2701
  • Fax:
Mailing address:
  • Phone: 503-782-8242
  • Fax: 503-862-5060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ARIANA LEE
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 971-373-4165