Provider Demographics
NPI:1215486626
Name:PEOPLES COMMUNITY CLINIC OF NEWBERG LLC
Entity type:Organization
Organization Name:PEOPLES COMMUNITY CLINIC OF NEWBERG LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:ARIELLE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-449-8988
Mailing Address - Street 1:1014 N SPRINGBROOK RD STE B
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-2061
Mailing Address - Country:US
Mailing Address - Phone:503-449-8988
Mailing Address - Fax:503-894-9194
Practice Address - Street 1:1014 N SPRINGBROOK RD STE B
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2061
Practice Address - Country:US
Practice Address - Phone:503-449-8988
Practice Address - Fax:503-894-9194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
OR201350039NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500720379Medicaid