Provider Demographics
NPI:1760628838
Name:PROFESSIONAL HEALTH CARE LLC
Entity Type:Organization
Organization Name:PROFESSIONAL HEALTH CARE LLC
Other - Org Name:GET A FLU SHOT.COM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLRED
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:503-258-9800
Mailing Address - Street 1:135 SE 102ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2703
Mailing Address - Country:US
Mailing Address - Phone:503-258-9800
Mailing Address - Fax:503-258-8311
Practice Address - Street 1:135 SE 102ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2703
Practice Address - Country:US
Practice Address - Phone:503-258-9800
Practice Address - Fax:503-258-8311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-19
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR081047114N3261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR213900Medicaid
OR213900Medicaid