Provider Demographics
NPI:1912283805
Name:LAURA CENTER PC
Entity Type:Organization
Organization Name:LAURA CENTER PC
Other - Org Name:THE LAURA CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:CHESHIRE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:541-526-5801
Mailing Address - Street 1:PO BOX 2042
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-0535
Mailing Address - Country:US
Mailing Address - Phone:541-526-5801
Mailing Address - Fax:
Practice Address - Street 1:218 SW 4TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2312
Practice Address - Country:US
Practice Address - Phone:541-526-5801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR80046130N1261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care