Provider Demographics
NPI:1356693873
Name:MILWAUKIE URGENT CARE
Entity type:Organization
Organization Name:MILWAUKIE URGENT CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:CAMILLE
Authorized Official - Last Name:JOYNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-659-4444
Mailing Address - Street 1:2403 SE MONROE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-7646
Mailing Address - Country:US
Mailing Address - Phone:503-659-4444
Mailing Address - Fax:503-659-1661
Practice Address - Street 1:2403 SE MONROE ST
Practice Address - Street 2:SUITE A
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-7646
Practice Address - Country:US
Practice Address - Phone:503-659-4444
Practice Address - Fax:503-659-1661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-08
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21092261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR130251Medicaid
OR130251Medicaid
107327Medicare PIN