Provider Demographics
NPI:1669429262
Name:ALLERGY ASTHMA CLINIC PC
Entity type:Organization
Organization Name:ALLERGY ASTHMA CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-631-4302
Mailing Address - Street 1:20561 S ADAMS VISTA CT
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-7358
Mailing Address - Country:US
Mailing Address - Phone:503-631-4302
Mailing Address - Fax:503-631-4035
Practice Address - Street 1:14279 GLEN OAK RD
Practice Address - Street 2:STE 204
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-8008
Practice Address - Country:US
Practice Address - Phone:503-631-4302
Practice Address - Fax:503-631-4035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD12758261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR838724000OtherBCBS GROUP
OR009196Medicaid
ORMD12758OtherMD LICENSE
ORMD12758OtherMD LICENSE
ORC91236Medicare UPIN
OR838724000OtherBCBS GROUP