Provider Demographics
NPI:1528625639
Name:PACIFIC PRIMARY CARE AND INTEGRATIVE HEALTH, INC.
Entity type:Organization
Organization Name:PACIFIC PRIMARY CARE AND INTEGRATIVE HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR. OF CLINICAL OUTCOMES
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:WILSON CRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-487-3001
Mailing Address - Street 1:728 MOLALLA AVE
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-2799
Mailing Address - Country:US
Mailing Address - Phone:503-487-3001
Mailing Address - Fax:503-656-9026
Practice Address - Street 1:17200 NW CORRIDOR CT STE 110
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-3295
Practice Address - Country:US
Practice Address - Phone:503-213-3800
Practice Address - Fax:503-747-5345
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PACIFIC PRIMARY CARE AND INTEGRATIVE HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty