Provider Demographics
NPI:1689739757
Name:ROSE CITY CLINIC LLP
Entity Type:Organization
Organization Name:ROSE CITY CLINIC LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FRIEND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-282-0979
Mailing Address - Street 1:5635 NE ALAMEDA ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-3421
Mailing Address - Country:US
Mailing Address - Phone:503-282-0979
Mailing Address - Fax:
Practice Address - Street 1:5635 NE ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-3421
Practice Address - Country:US
Practice Address - Phone:503-282-0979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19915207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty