Provider Demographics
NPI:1255468179
Name:HILLSBORO URGENT CARE AND OCCUPATIONAL HEALTH
Entity Type:Organization
Organization Name:HILLSBORO URGENT CARE AND OCCUPATIONAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:503-648-8210
Mailing Address - Street 1:434 S 1ST AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-3982
Mailing Address - Country:US
Mailing Address - Phone:503-648-8210
Mailing Address - Fax:506-648-8283
Practice Address - Street 1:434 S 1ST AVE
Practice Address - Street 2:STE 300
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-3982
Practice Address - Country:US
Practice Address - Phone:503-648-8210
Practice Address - Fax:506-648-8283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18724207Q00000X, 2083A0100X, 2083X0100X, 261QP2300X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace MedicineGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR029029Medicaid
FLF49337Medicare UPIN
ORR118952Medicare ID - Type UnspecifiedURGENT CARE