Provider Demographics
NPI:1043572852
Name:HEART SPRING HEALTH
Entity Type:Organization
Organization Name:HEART SPRING HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SERRON
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKIE
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-956-9396
Mailing Address - Street 1:4804 SE LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3841
Mailing Address - Country:US
Mailing Address - Phone:503-956-9396
Mailing Address - Fax:
Practice Address - Street 1:4804 SE LINCOLN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-3841
Practice Address - Country:US
Practice Address - Phone:503-956-9396
Practice Address - Fax:866-833-0582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1851625560OtherNPI