Provider Demographics
NPI:1427662204
Name:EDMUND H. TORKELSON DO, PC
Entity type:Organization
Organization Name:EDMUND H. TORKELSON DO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TORKELSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:503-614-8735
Mailing Address - Street 1:1960 NW 167TH PL STE 204
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-4804
Mailing Address - Country:US
Mailing Address - Phone:503-614-8735
Mailing Address - Fax:503-614-8749
Practice Address - Street 1:1960 NW 167TH PL STE 204
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-4804
Practice Address - Country:US
Practice Address - Phone:503-614-8735
Practice Address - Fax:503-614-8749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center