Provider Demographics
NPI:1386754398
Name:EASTMORELAND EAR, NOSE & THROAT, CLINIC, LLP
Entity type:Organization
Organization Name:EASTMORELAND EAR, NOSE & THROAT, CLINIC, LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-233-5548
Mailing Address - Street 1:9280 SE SUNNYBROOK BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-9353
Mailing Address - Country:US
Mailing Address - Phone:503-233-5548
Mailing Address - Fax:866-663-1070
Practice Address - Street 1:9280 SE SUNNYBROOK BLVD STE 300
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9353
Practice Address - Country:US
Practice Address - Phone:503-233-5548
Practice Address - Fax:503-230-1009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR109148Medicare ID - Type Unspecified