Provider Demographics
NPI:1720386147
Name:SHAY LAW LMT LLC
Entity Type:Organization
Organization Name:SHAY LAW LMT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-936-7289
Mailing Address - Street 1:111 SW COLUMBIA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5848
Mailing Address - Country:US
Mailing Address - Phone:503-222-0551
Mailing Address - Fax:503-224-9619
Practice Address - Street 1:111 SW COLUMBIA ST STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-5848
Practice Address - Country:US
Practice Address - Phone:503-222-0551
Practice Address - Fax:503-224-9619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes302R00000XManaged Care OrganizationsHealth Maintenance OrganizationGroup - Single Specialty