Provider Demographics
NPI:1295287415
Name:TALISMAN ACUPUNCTURE LLC
Entity type:Organization
Organization Name:TALISMAN ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-287-9889
Mailing Address - Street 1:3024 NE 63RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-4510
Mailing Address - Country:US
Mailing Address - Phone:503-287-9889
Mailing Address - Fax:855-395-9094
Practice Address - Street 1:3024 NE 63RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-4510
Practice Address - Country:US
Practice Address - Phone:503-287-9889
Practice Address - Fax:855-395-9094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC175531261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1205295466OtherPROVIDER NPI
OR500713157Medicaid
OR500713157Medicaid