=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871818070
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | URGENT OREGON CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2010
-----------------------------------------------------
Last Update Date | 03/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5305 E 18TH ST SUITE 224
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98661-6583
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-550-8002
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5305 E 18TH ST SUITE 224
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98661-6583
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-550-8002
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KAREN KHANOYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 360-550-8002
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------