Provider Demographics
NPI:1417098773
Name:ORCHID OAKRIDGE CLINIC, PC
Entity Type:Organization
Organization Name:ORCHID OAKRIDGE CLINIC, PC
Other - Org Name:ORCHID HEALTH SANDY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ARIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-373-4165
Mailing Address - Street 1:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-0132
Mailing Address - Country:US
Mailing Address - Phone:541-822-3341
Mailing Address - Fax:541-822-3836
Practice Address - Street 1:54771 MCKENZIE HWY
Practice Address - Street 2:
Practice Address - City:BLUE RIVER
Practice Address - State:OR
Practice Address - Zip Code:97413-9790
Practice Address - Country:US
Practice Address - Phone:541-822-3341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR203935Medicaid
OR383802Medicare PIN
OR203935Medicaid