Provider Demographics
NPI:1275670614
Name:NEWBERG URGENT CARE AND MEDICAL CENTER
Entity Type:Organization
Organization Name:NEWBERG URGENT CARE AND MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUGUSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-537-9600
Mailing Address - Street 1:2880 HAYES ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-1310
Mailing Address - Country:US
Mailing Address - Phone:503-537-9600
Mailing Address - Fax:503-537-0105
Practice Address - Street 1:2880 HAYES ST
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1310
Practice Address - Country:US
Practice Address - Phone:503-537-9600
Practice Address - Fax:503-537-0105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty