Provider Demographics
NPI:1013341064
Name:COLUMBIA MEDICAL CLINIC, PC
Entity Type:Organization
Organization Name:COLUMBIA MEDICAL CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOANG
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-255-1111
Mailing Address - Street 1:9710 SE WASHINGTON ST STE B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-8407
Mailing Address - Country:US
Mailing Address - Phone:503-261-8000
Mailing Address - Fax:503-777-8005
Practice Address - Street 1:9710 SE WASHINGTON ST STE B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-8407
Practice Address - Country:US
Practice Address - Phone:503-261-8000
Practice Address - Fax:503-777-8005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR135648Medicare PIN