Provider Demographics
NPI:1841485869
Name:RONALD W. POWELL, D.O.,P.C.
Entity type:Organization
Organization Name:RONALD W. POWELL, D.O.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MONROE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-657-3158
Mailing Address - Street 1:1673 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-4607
Mailing Address - Country:US
Mailing Address - Phone:503-657-3158
Mailing Address - Fax:503-657-4579
Practice Address - Street 1:1673 10TH ST
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-4607
Practice Address - Country:US
Practice Address - Phone:503-657-3158
Practice Address - Fax:503-657-4579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO11790207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR218545Medicaid
OR218545Medicaid
OR114202Medicare PIN