Provider Demographics
NPI:1467453316
Name:WOMENS HEALTHCARE CLINIC OF OREGON PC
Entity Type:Organization
Organization Name:WOMENS HEALTHCARE CLINIC OF OREGON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-256-1470
Mailing Address - Street 1:10000 SE MAIN ST STE 236
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2469
Mailing Address - Country:US
Mailing Address - Phone:503-256-1470
Mailing Address - Fax:503-256-1283
Practice Address - Street 1:10000 SE MAIN ST STE 236
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2469
Practice Address - Country:US
Practice Address - Phone:503-256-1470
Practice Address - Fax:503-265-1283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18458207V00000X
CAG70228207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR276704Medicaid
102321Medicare ID - Type Unspecified