# CG GROUP ASTORIA MEDICAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013098094
- **Authorized official:** MICHAEL W LARY (ADMINISTRATOR)
- **Authorized official phone:** (503) 861-6244

## Contact information

- **Practice address:** 2185 SE 12TH PL, WARRENTON, OR 97146-9311
- **Practice address phone:** (503) 861-6240
- **Practice address fax:** (503) 861-6358
- **Mailing address:** 2185 SE 12TH PL, WARRENTON, OR 97146-9311
- **Mailing address phone:** (503) 861-6240
- **Mailing address fax:** (503) 861-6358

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | — |
| 1223G0001X | General Practice Dentistry | — | — | — |
| 124Q00000X | Dental Hygienist | — | NULL | — |
| 124Q00000X | Dental Hygienist | — | — | — |
| 207QA0505X | Adult Medicine Physician | — | NULL | — |
| 207QA0505X | Adult Medicine Physician | — | — | — |
| 363AM0700X | Medical Physician Assistant | — | NULL | Yes |
| 363AM0700X | Medical Physician Assistant | — | — | Yes |

## Other

- **Enumeration date:** 10/18/2006
- **Last updated:** 09/11/2025