Provider Demographics
NPI:1518945922
Name:OREGON CITY FOOT CLINIC, PC
Entity Type:Organization
Organization Name:OREGON CITY FOOT CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:503-655-0775
Mailing Address - Street 1:1510 DIVISION ST
Mailing Address - Street 2:SUITE 80
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-1581
Mailing Address - Country:US
Mailing Address - Phone:503-655-0775
Mailing Address - Fax:503-655-0751
Practice Address - Street 1:1510 DIVISION ST
Practice Address - Street 2:SUITE 80
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1581
Practice Address - Country:US
Practice Address - Phone:503-655-0775
Practice Address - Fax:503-655-0751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00269261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR3004485OtherBLUECROSS BLUESHIELD HMO
OR158763Medicaid
ORR115787Medicare ID - Type Unspecified
ORDA4093Medicare ID - Type UnspecifiedMEDICARE RAILROAD
OR158763Medicaid