Organization
PACIFIC MEDICAL GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN M CLACK MD (CEO)
(503) 598-2000
Entity
Organization
Contact information
Practice address
6 CENTERPOINTE DRIVE, STE 200, LAKE OSWEGO, OR 97035
(503) 234-6381
(503) 234-8151
Mailing address
6 CENTERPOINTE DR STE 200, LAKE OSWEGO, OR 97035-8660
(503) 234-6381
(503) 234-8151
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
230547
—
OR
05
—
230548
—
OR
05
—
230549
—
OR
05
—
230550
—
OR
05
—
230589
—
OR
01
—
CC6737
RR MEDICARE
OR
Enumeration date
10/23/2006
Last updated
11/20/2007
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