Provider Demographics
NPI:1235130857
Name:NEWSTART PMR CLINIC, P.C.
Entity Type:Organization
Organization Name:NEWSTART PMR CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:G
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-253-3882
Mailing Address - Street 1:10101 SE MAIN ST STE 2016
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2457
Mailing Address - Country:US
Mailing Address - Phone:503-253-3882
Mailing Address - Fax:503-253-2848
Practice Address - Street 1:10101 SE MAIN ST STE 2016
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2457
Practice Address - Country:US
Practice Address - Phone:503-253-3882
Practice Address - Fax:503-253-2848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-04
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD14393208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR135657Medicaid
ORR134350OtherMEDICARE
OR135657Medicaid