Provider Demographics
NPI:1306481981
Name:NEIGHBORHOOD PHYSICIAN NETWORK LLC
Entity type:Organization
Organization Name:NEIGHBORHOOD PHYSICIAN NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KOSIK
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGING PARTNER
Authorized Official - Phone:503-470-9844
Mailing Address - Street 1:3374 SE HOLGATE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3459
Mailing Address - Country:US
Mailing Address - Phone:503-470-9844
Mailing Address - Fax:503-447-2076
Practice Address - Street 1:3374 SE HOLGATE BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3459
Practice Address - Country:US
Practice Address - Phone:503-470-9844
Practice Address - Fax:503-447-2076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-07
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL19000235674OtherSTATE OF FLORIDA, DEPARTMENT OF STATE CERTIFICATE OF LLC