Provider Demographics
NPI:1366495301
Name:FAMILY CLINIC P C
Entity Type:Organization
Organization Name:FAMILY CLINIC P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:SOHRIAKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:503-648-1121
Mailing Address - Street 1:527 SE BASELINE RD
Mailing Address - Street 2:STE E
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4149
Mailing Address - Country:US
Mailing Address - Phone:503-648-1121
Mailing Address - Fax:503-648-1124
Practice Address - Street 1:527 SE BASELINE RD
Practice Address - Street 2:STE E
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4149
Practice Address - Country:US
Practice Address - Phone:503-648-1121
Practice Address - Fax:503-648-1124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD012215207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR208090Medicaid
OR208090Medicaid
E41617Medicare UPIN