Organization
OREGON CITY MEDICAL NW INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DANIELLE L BLACKWELL (OWNER)
(503) 656-9030
Entity
Organization
Contact information
Practice address
728 MOLALLA AVE STE A&B, OREGON CITY, OR 97045-2799
(503) 656-9030
(503) 656-9026
Mailing address
728 MOLALLA AVE STE A&B, OREGON CITY, OR 97045-2799
(503) 656-9030
(503) 656-9026
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QA0005X
Ambulatory Family Planning Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
218463
—
OR
01
—
838553000
BLUE CROSS GROUP ID
OR
Enumeration date
05/29/2007
Last updated
10/31/2014
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