Provider Demographics
NPI:1578917076
Name:ORCHID OAKRIDGE CLINIC, P.C.
Entity Type:Organization
Organization Name:ORCHID OAKRIDGE CLINIC, P.C.
Other - Org Name:ORCHID HEALTH - WADE CREEK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:ORION
Authorized Official - Middle Name:
Authorized Official - Last Name:FALVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-314-0100
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:541-782-8242
Mailing Address - Fax:
Practice Address - Street 1:535 NE 6TH AVE
Practice Address - Street 2:
Practice Address - City:ESTACADA
Practice Address - State:OR
Practice Address - Zip Code:97023-9312
Practice Address - Country:US
Practice Address - Phone:541-632-3031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500721884Medicaid