Organization
ROSE CITY MEDICAL LLC
Active
Other names
Rose City Urgent Care and Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA LYNN SULLIVAN (BUSINESS DIRECTOR)
(503) 894-9005
Entity
Organization
Contact information
Practice address
135 NE 102ND AVE, PORTLAND, OR 97220-4167
(503) 894-9005
(503) 719-4178
Mailing address
135 NE 102ND AVE, PORTLAND, OR 97220-4167
(503) 894-9005
(503) 719-4178
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
85696897
OR
261QU0200X
Urgent Care Clinic/Center
85696897
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500646730
—
OR
01
—
R167408
MEDICARE PTAN
OR
Enumeration date
05/20/2012
Last updated
02/26/2016
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