Provider Demographics
NPI:1710349477
Name:UPTOWN PROVIDERS PC
Entity Type:Organization
Organization Name:UPTOWN PROVIDERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CENTER DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GURU
Authorized Official - Middle Name:
Authorized Official - Last Name:SANKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-305-6262
Mailing Address - Street 1:14284 SW ALLEN BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-4405
Mailing Address - Country:US
Mailing Address - Phone:503-305-6262
Mailing Address - Fax:
Practice Address - Street 1:14284 SW ALLEN BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4405
Practice Address - Country:US
Practice Address - Phone:503-305-6262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208D00000X, 291U00000X
OR261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty