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General NPI Number Information
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NPI Number | 1477636561
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Entity Type | Organization
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Legal Business Name | PACIFIC MEDICAL GROUP, PC
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 11/20/2007
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Provider Practice Location Address
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Address Line | 6 CENTERPOINTE DRIVE, STE 200
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City | LAKE OSWEGO
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State | OR
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Zip | 97035
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Country | US
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Telephone | 503-234-6381
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Fax | 503-234-8151
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Provider Business Mailing Address
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Address Line | 6 CENTERPOINTE DR STE 200
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-8660
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Country | US
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Telephone | 503-234-6381
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Fax | 503-234-8151
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Authorized Official
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Title or Position | CEO
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Name | DR. SUSAN M CLACK
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Credential | MD
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Telephone | 503-598-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | OR
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