Provider Demographics
NPI:1033318431
Name:GPS II PC
Entity Type:Organization
Organization Name:GPS II PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-201-9811
Mailing Address - Street 1:5402 SW JOSHUA ST
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-9771
Mailing Address - Country:US
Mailing Address - Phone:503-201-9811
Mailing Address - Fax:
Practice Address - Street 1:5402 SW JOSHUA ST
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9771
Practice Address - Country:US
Practice Address - Phone:503-201-9811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care