Provider Demographics
NPI:1013098094
Name:CG GROUP ASTORIA MEDICAL CLINIC
Entity Type:Organization
Organization Name:CG GROUP ASTORIA MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:LARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-861-6244
Mailing Address - Street 1:2185 SE 12TH PL
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:OR
Mailing Address - Zip Code:97146-9311
Mailing Address - Country:US
Mailing Address - Phone:503-861-6240
Mailing Address - Fax:503-861-6358
Practice Address - Street 1:2185 SE 12TH PL
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:OR
Practice Address - Zip Code:97146-9311
Practice Address - Country:US
Practice Address - Phone:503-861-6240
Practice Address - Fax:503-861-6358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
Not Answered207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty