Provider Demographics
NPI:1134563620
Name:UPTOWN PROVIDERS INC
Entity type:Organization
Organization Name:UPTOWN PROVIDERS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CENTER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GURU
Authorized Official - Middle Name:
Authorized Official - Last Name:SANKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-305-6262
Mailing Address - Street 1:8060 SW PFAFFLE ST STE 106
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8489
Mailing Address - Country:US
Mailing Address - Phone:503-305-6262
Mailing Address - Fax:503-305-6078
Practice Address - Street 1:6633 NE SANDY BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-5284
Practice Address - Country:US
Practice Address - Phone:503-305-6262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-26
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
R162667Medicare UPIN