Gresham Sportscare, Pc

NPI 1487789657 - Clinic/Center - 261QP2000X

NPI Details
NPI 1487789657
Enumeration Date 02/21/2007
Last Updated 05/27/2009
Entity Type Healthcare Provider
Active Over 9 years ago
Authorized Information
Name C. GEORGE C.
Position OWNER
Phone (503) 491-1666
Fax
Practice Location
24076 SE STARK ST
STE. 200
GRESHAM OR, 97030-3373, US
Phone (503) 491-1666
Fax
Business Location
24076 SE STARK ST
STE. 200
GRESHAM OR, 97030-3373, US
Phone (503) 491-1666
Fax
Toxanomy
Taxonomy Code 261QP2000X
License State Oregon
License Number 1517
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According to our database, Gresham Sportscare, Pc NPI is 1487789657, taxonomy code is 261QP2000X and license number is 1517, license state is located at Oregon. Gresham Sportscare, Pc physically located at 24076 Se Stark St, Gresham OR, 97030-3373. NPI Number 1033115704 has the healthcare provider type.

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1487789657 NPI number is provided on an as is basis without warranty of any kind. 1487789657 is maintained by the National Plan & Provider Enumeration System. The contents of Gresham Sportscare, Pc are for informational purposes only.