MEDICARE: METIS CLINICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor	7329	OR

General Provider Information

NPI Number	:	1174937973
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METIS CLINICS LLC

Provider Business Mailing Address
First Line	:	7110 SW FIR LOOP
Second Line	:	SUITE 210
City	:	TIGARD
State	:	OR
Zip	:	97223-8084
Country	:	US
Telephone Number	:	503-819-2904
Fax Number	:	503-746-7432

Provider Business Practice Location Address
First Line	:	7110 SW FIR LOOP
Second Line	:	SUITE 210
City	:	TIGARD
State	:	OR
Zip	:	97223-8084
Country	:	US
Telephone Number	:	503-819-2904
Fax Number	:	503-746-7432

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MISS TARA PELTON
Credential	:
Telephone Number	:	503-819-2904

Provider Enumeration Date	:	06/19/2014
Last Update Date	:	06/19/2014

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