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ROBERTS STREET CLINIC P.C. NPI 1003024423


NPI Information

NPI: 1003024423
Provider Name: ROBERTS STREET CLINIC, P.C.
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 38D0621896

Address:
400 NE ROBERTS AVE
GRESHAM, OR
ZIP 97030
Phone: (503) 669-3066
Get Directions

ROBERTS STREET CLINIC, P.C. is a family medicine in Gresham, OR. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. ROBERTS STREET CLINIC, P.C. NPI is 1003024423. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

400 NE ROBERTS AVE
GRESHAM, OR
ZIP 97030-464
Phone: (503) 669-3066
Fax: (503) 665-6404

The provider's authorized official is Linda Mankey .
The authorized official title is Clinic Manager and has the following contact phone number (503) 669-3066.

The CLIA number assigned to this NPI record is 38D0621896 - physician office with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 5/18/2007 and was last updated on 10/10/2007.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineDO15150OREGONNo
2207Q00000XFamily MedicineDO21884OREGONNo
3207R00000XInternal MedicineMD17149OREGONNo
4207Q00000XFamily MedicineDO18839OREGONYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
108WFBBRAMEDICARE ID-TYPE UNSPECIFIEDOREGON
2011WFBBRAMEDICARE ID-TYPE UNSPECIFIEDOREGON
3287698MEDICAIDOREGON
4205823MEDICAIDOREGON
5D80358MEDICARE UPINOREGON
6H34118MEDICARE UPINOREGON
7079546MEDICAIDOREGON
8G23129MEDICARE UPINOREGON
9287658MEDICAIDOREGON
10109162MEDICARE ID-TYPE UNSPECIFIEDOREGON
110000WFBBRMEDICARE ID-TYPE UNSPECIFIEDOREGON
12029582MEDICAIDOREGON
13E96441MEDICARE UPINOREGON
14118823MEDICARE ID-TYPE UNSPECIFIEDOREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.