Provider Demographics
NPI:1205226214
Name:LANDMARK HEALTH OF OREGON LLC
Entity Type:Organization
Organization Name:LANDMARK HEALTH OF OREGON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PAYOR OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:STORTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-824-0735
Mailing Address - Street 1:7755 CENTER AVE
Mailing Address - Street 2:#630
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9020 SW WASHINGTON SQUARE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-4436
Practice Address - Country:US
Practice Address - Phone:877-240-3112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LANDMARK HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty