Provider Demographics
NPI:1063660694
Name:PORTLAND INTERNAL MEDICINE OFFICES OF JAMES V. SKAVARIL MD LLC
Entity Type:Organization
Organization Name:PORTLAND INTERNAL MEDICINE OFFICES OF JAMES V. SKAVARIL MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:V
Authorized Official - Last Name:SKAVARIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-230-9224
Mailing Address - Street 1:5050 NE HOYT ST
Mailing Address - Street 2:STE 203
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2991
Mailing Address - Country:US
Mailing Address - Phone:503-230-9224
Mailing Address - Fax:503-230-9201
Practice Address - Street 1:5050 NE HOYT ST
Practice Address - Street 2:STE 203
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2991
Practice Address - Country:US
Practice Address - Phone:503-230-9224
Practice Address - Fax:503-230-9201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20409207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR130094Medicaid
ORR144466Medicare PIN
OR130094Medicaid