Provider Demographics
NPI:1326473075
Name:AMY KILLEN, MD, LLC
Entity Type:Organization
Organization Name:AMY KILLEN, MD, LLC
Other - Org Name:BODYLOGICMD OF PORTLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-767-8105
Mailing Address - Street 1:1221 SW YAMHILL ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2126
Mailing Address - Country:US
Mailing Address - Phone:877-291-9611
Mailing Address - Fax:
Practice Address - Street 1:1221 SW YAMHILL ST
Practice Address - Street 2:SUITE 300
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2126
Practice Address - Country:US
Practice Address - Phone:877-291-9611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD164143174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty