Provider Demographics
NPI:1043577869
Name:VERDURA FAMILY WELLNESS, INC
Entity Type:Organization
Organization Name:VERDURA FAMILY WELLNESS, INC
Other - Org Name:VERDURA FAMILY WELLNESS, INC-CARLTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-648-8210
Mailing Address - Street 1:434 S 1ST AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-3957
Mailing Address - Country:US
Mailing Address - Phone:503-648-8210
Mailing Address - Fax:503-648-8283
Practice Address - Street 1:348 S PINE ST
Practice Address - Street 2:
Practice Address - City:CARLTON
Practice Address - State:OR
Practice Address - Zip Code:97111-1228
Practice Address - Country:US
Practice Address - Phone:503-648-8210
Practice Address - Fax:503-648-8283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty