Provider Demographics
NPI:1770147357
Name:UPTOWN PROVIDERS PC
Entity type:Organization
Organization Name:UPTOWN PROVIDERS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CENTER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GURU
Authorized Official - Middle Name:
Authorized Official - Last Name:SANKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-744-0399
Mailing Address - Street 1:8060 SW PFAFFLE ST STE 106
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8489
Mailing Address - Country:US
Mailing Address - Phone:971-233-0435
Mailing Address - Fax:877-991-8038
Practice Address - Street 1:397 WARNER MILNE RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4045
Practice Address - Country:US
Practice Address - Phone:503-305-6262
Practice Address - Fax:877-991-8038
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPTOWN PROVIDERS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-29
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care