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General NPI Number Information
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NPI Number | 1306701941
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Entity Type | Organization
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Legal Business Name | MIO SPA LLC
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Dates
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Enumeration Date | 12/17/2025
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 901 N BRUTSCHER ST
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City | NEWBERG
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State | OR
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Zip | 97132-6096
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Country | US
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Telephone | 503-538-0100
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Fax | 971-762-3357
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Provider Business Mailing Address
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Address Line | 18157 SW SHADY MEADOW CT
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City | BEAVERTON
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State | OR
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Zip | 97007-6764
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARK CHRISTENSON
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Credential |
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Telephone | 503-538-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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