Provider Demographics
NPI:1558813063
Name:HEART CENTERED MEDICINE
Entity Type:Organization
Organization Name:HEART CENTERED MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:BISWAS
Authorized Official - Last Name:YORK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, MSW, MACOM
Authorized Official - Phone:503-432-3110
Mailing Address - Street 1:4230 SE KING RD # 179
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-5259
Mailing Address - Country:US
Mailing Address - Phone:503-432-3110
Mailing Address - Fax:
Practice Address - Street 1:3689 CARMAN DR STE 300
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-2620
Practice Address - Country:US
Practice Address - Phone:503-432-3110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC179946171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty