Organization
LAKE GROVE FAMILY MEDICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON K SABINS (ASSISTANT CLINIC MANAGER)
(503) 635-1350
Entity
Organization
Contact information
Practice address
16463 BOONES FERRY RD, SUITE 100, LAKE OSWEGO, OR 97035-4259
(503) 635-1350
(503) 635-8470
Mailing address
16463 BOONES FERRY RD, SUITE 100, LAKE OSWEGO, OR 97035-4259
(503) 635-1350
(503) 635-8470
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
DO14260
OR
261QP2300X
Primary Care Clinic/Center
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—
Other
Enumeration date
02/27/2017
Last updated
11/03/2020
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