Provider Demographics
NPI:1760049886
Name:PACIFIC PRIMARY CARE AND INTEGRATIVE HEALTH, INC.
Entity Type:Organization
Organization Name:PACIFIC PRIMARY CARE AND INTEGRATIVE HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL OUTCOMES
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:WILSON CRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-487-3001
Mailing Address - Street 1:728 MOLALLA AVE
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-2799
Mailing Address - Country:US
Mailing Address - Phone:035-656-9030
Mailing Address - Fax:503-656-9026
Practice Address - Street 1:800 SE 181ST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-4995
Practice Address - Country:US
Practice Address - Phone:503-489-9500
Practice Address - Fax:503-328-8508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty