Provider Demographics
NPI:1821544396
Name:CC DOCTORS CENTER PORTLAND, PLLC
Entity Type:Organization
Organization Name:CC DOCTORS CENTER PORTLAND, PLLC
Other - Org Name:THE DOCTORS CENTER URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-651-1200
Mailing Address - Street 1:4637 S PADRE ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4413
Mailing Address - Country:US
Mailing Address - Phone:361-852-6824
Mailing Address - Fax:361-814-6828
Practice Address - Street 1:125 NORTHSHORE BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-4206
Practice Address - Country:US
Practice Address - Phone:361-852-6824
Practice Address - Fax:361-814-6828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-25
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4486261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care