Provider Demographics
NPI:1215386776
Name:CLEAR PATH CENTER, P.A.
Entity Type:Organization
Organization Name:CLEAR PATH CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AWAIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-324-4594
Mailing Address - Street 1:2364 MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHILOMATH
Mailing Address - State:OR
Mailing Address - Zip Code:97370-9488
Mailing Address - Country:US
Mailing Address - Phone:541-324-4594
Mailing Address - Fax:541-708-0949
Practice Address - Street 1:2364 MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:PHILOMATH
Practice Address - State:OR
Practice Address - Zip Code:97370-9488
Practice Address - Country:US
Practice Address - Phone:541-324-4594
Practice Address - Fax:541-708-0949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD176723207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty