Provider Demographics
NPI:1124783345
Name:OREGON INSTITUTE OF FOOT CARE LLC
Entity type:Organization
Organization Name:OREGON INSTITUTE OF FOOT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:503-635-7742
Mailing Address - Street 1:55 S STATE ST STE 3220
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3975
Mailing Address - Country:US
Mailing Address - Phone:503-635-7742
Mailing Address - Fax:
Practice Address - Street 1:55 S STATE ST STE 3220
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3975
Practice Address - Country:US
Practice Address - Phone:503-635-7742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiologyGroup - Single Specialty
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty