Provider Demographics
NPI:1891852570
Name:HEALTHMAX LLC
Entity Type:Organization
Organization Name:HEALTHMAX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-243-6614
Mailing Address - Street 1:2050 NW LOVEJOY ST
Mailing Address - Street 2:STE 1
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1670
Mailing Address - Country:US
Mailing Address - Phone:503-243-6614
Mailing Address - Fax:503-243-6632
Practice Address - Street 1:2050 NW LOVEJOY ST
Practice Address - Street 2:STE 1
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1670
Practice Address - Country:US
Practice Address - Phone:503-243-6614
Practice Address - Fax:503-243-6632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI113762Medicare ID - Type Unspecified