Provider Demographics
NPI:1336817972
Name:CREATE HEATH NW
Entity Type:Organization
Organization Name:CREATE HEATH NW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:971-344-7365
Mailing Address - Street 1:1975 NW 167TH PL # 100-42
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-4908
Mailing Address - Country:US
Mailing Address - Phone:971-344-7365
Mailing Address - Fax:
Practice Address - Street 1:1975 NW 167TH PL # 100-42
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-4908
Practice Address - Country:US
Practice Address - Phone:971-344-7365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORDO171244OtherOREGON MEDICAL BOARD
WAOP60798348OtherWASHINGTON STATE DEPARTMENT OF HEALTH