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ESTACADA DIRECT PRIMARY CARE LLC NPI 1801663414


NPI Information

NPI: 1801663414
Provider Name: ESTACADA DIRECT PRIMARY CARE, LLC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 38D2291363

Address:
107 NW 5TH AVE
ESTACADA, OR
ZIP 97023
Phone: (503) 852-5668
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ESTACADA DIRECT PRIMARY CARE, LLC is a primary care clinic center in Estacada, OR. ESTACADA DIRECT PRIMARY CARE, LLC NPI is 1801663414. The provider is registered as an organization entity type.

The provider's business location address is:

107 NW 5TH AVE
ESTACADA, OR
ZIP 97023-732
Phone: (503) 852-5668
Fax: (971) 399-8728

The provider's authorized official is Richard Lee Orth .
The authorized official title is Owner and has the following contact phone number (503) 852-5668.

The CLIA number assigned to this NPI record is 38D2291363 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/5/2023 and was last updated on 12/5/2023.


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
1261QP2300XClinic/CenterPrimary CareYes

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

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