# LAKE MEDICAL CLINIC, INC.

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

## Provider details

- **NPI number:** 1871693564
- **Authorized official:** EDWARD E CONRAD JR. MD (VICE PRESIDENT)
- **Authorized official phone:** (503) 635-5044

## Contact information

- **Practice address:** 550 3RD ST, LAKE OSWEGO, OR 97034-3002
- **Practice address phone:** (503) 635-5044
- **Practice address fax:** (503) 635-3255
- **Mailing address:** PO BOX 365, LAKE OSWEGO, OR 97034-0042
- **Mailing address phone:** (503) 635-5044
- **Mailing address fax:** (503) 635-3255

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 12913 | OR | Yes |

## Other

- **Enumeration date:** 09/23/2006
- **Last updated:** 08/22/2020