Provider Demographics
NPI:1437328903
Name:SHERWOOD FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:SHERWOOD FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-515-6269
Mailing Address - Street 1:20015 SW PACIFIC HWY
Mailing Address - Street 2:SUITE 221
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140
Mailing Address - Country:US
Mailing Address - Phone:503-625-2848
Mailing Address - Fax:503-625-2899
Practice Address - Street 1:20015 SW PACIFIC HWY
Practice Address - Street 2:SUITE 221
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140
Practice Address - Country:US
Practice Address - Phone:503-625-2848
Practice Address - Fax:503-625-2899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23583261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR287118Medicaid