Healthcare Provider Details

I. General information

NPI: 1346903531
Provider Name (Legal Business Name): UPTOWN PROVIDERS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2021
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11675 SW PACIFIC HWY
TIGARD OR
97223-8672
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:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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: 503-305-6262