Provider Demographics
NPI:1669805388
Name:UNITED MEDICAL GROUP, PC
Entity type:Organization
Organization Name:UNITED MEDICAL GROUP, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-788-6483
Mailing Address - Street 1:9975 SW FREWING ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5091
Mailing Address - Country:US
Mailing Address - Phone:503-788-6483
Mailing Address - Fax:503-772-7914
Practice Address - Street 1:9975 SW FREWING ST
Practice Address - Street 2:SUITE 110
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-5091
Practice Address - Country:US
Practice Address - Phone:503-788-6483
Practice Address - Fax:503-772-7914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR952793-95261QU0200X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care