Provider Demographics
NPI:1720151905
Name:HARBOR ORTHOPEDIC AND FRACTURE CLINIC
Entity Type:Organization
Organization Name:HARBOR ORTHOPEDIC AND FRACTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-532-3808
Mailing Address - Street 1:1211 SKYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-1099
Mailing Address - Country:US
Mailing Address - Phone:360-532-3808
Mailing Address - Fax:360-533-4884
Practice Address - Street 1:1211 SKYVIEW DR
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-1099
Practice Address - Country:US
Practice Address - Phone:360-532-3808
Practice Address - Fax:360-533-4884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL106056OtherL&I