Provider Demographics
NPI:1316241078
Name:ELEMENTAL MEDICINE
Entity type:Organization
Organization Name:ELEMENTAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:EBLING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-505-9677
Mailing Address - Street 1:2915 SE BELMONT ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214
Mailing Address - Country:US
Mailing Address - Phone:503-505-9677
Mailing Address - Fax:
Practice Address - Street 1:2915 SE BELMONT ST
Practice Address - Street 2:SUITE 1
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214
Practice Address - Country:US
Practice Address - Phone:503-505-9677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC153123261QM1300X
OR8058261QM1300X
OR3917261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty