NPI Code Detail JSON Logo

1871434571 NPI number — ARBOR VITAE MEDICAL CLINIC LLC

NPI Number: 1871434571
Health Care Provider/Practitioner: ARBOR VITAE MEDICAL CLINIC LLC

Information about “1871434571” NPI (ARBOR VITAE MEDICAL CLINIC LLC) exists in 1871434571 in HTML format HTML  |  1871434571 in plain Text format TXT  |  1871434571 in PDF (Portable Document Format) PDF  |  1871434571 in an XML format XML  formats.

NPI Number : 1871434571 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1871434571",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "ARBOR VITAE MEDICAL CLINIC LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6825 SW SANDBURG ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TIGARD",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97223-8192",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "503-208-6254",
    "MailingAddressFaxNumber": "503-386-3241",
    "FirstLinePracticeLocationAddress": "6825 SW SANDBURG ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TIGARD",
    "PracticeLocationAddressStateName": "OR",
    "PracticeLocationAddressPostalCode": "97223-8192",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "503-208-6254",
    "PracticeLocationAddressFaxNumber": "503-386-3241",
    "EnumerationDate": "04/06/2026",
    "LastUpdateDate": "04/06/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "STORTRO",
    "AuthorizedOfficialFirstName": "JOEL",
    "AuthorizedOfficialMiddleName": "EDWARD",
    "AuthorizedOfficialTitle": "MANAGING MEMBER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "FNP-C",
    "AuthorizedOfficialTelephoneNumber": "503-208-6254",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QP2300X",
        "TaxonomyName": "Primary Care Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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