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NPI Code Detail

MEDICARE: PORTLAND ALTERNATIVE MEDICINE, LLC

MEDICARE: PORTLAND ALTERNATIVE MEDICINE, 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
1261Q00000XClinic/CenterOR

General Provider Information

NPI Number : 1194979252
Entity Type Code : Organization
Provider Name (Legal Business Name) : PORTLAND ALTERNATIVE MEDICINE, LLC
Provider Business Mailing Address
First Line : 4425 SW CORBETT AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97239-4260
Country : US
Telephone Number : 10-109-3425
Fax Number : 10-109-3425
Provider Business Practice Location Address
First Line : 4425 SW CORBETT AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97239-4260
Country : US
Telephone Number : 10-109-3425
Fax Number : 10-109-3425
Authorized Official
Title or Position : OWNER
Name : DR. WENDY HODSDON
Credential : N.D.
Telephone Number : 503-267-7460
Provider Enumeration Date : 11/14/2008
Last Update Date : 11/14/2008

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Directions to “PORTLAND ALTERNATIVE MEDICINE, LLC ” Practice Location

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