=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548960495
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BELOVED MEDICAL, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2023
-----------------------------------------------------
Last Update Date | 01/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25195 SW PARKWAY AVE STE 200
-----------------------------------------------------
City | WILSONVILLE
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97070-9689
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 971-710-4511
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25195 SW PARKWAY AVE STE 200
-----------------------------------------------------
City | WILSONVILLE
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97070-9689
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 971-710-4511
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | AMBER DEONNA PERELGUT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 971-710-4511
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207QG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------