Provider Demographics
NPI:1568287688
Name:GOLDMARK WOUND SPECIALTY GROUP MPO, LLC
Entity type:Organization
Organization Name:GOLDMARK WOUND SPECIALTY GROUP MPO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:971-910-3888
Mailing Address - Street 1:7150 SW HAMPTON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8365
Mailing Address - Country:US
Mailing Address - Phone:971-236-4445
Mailing Address - Fax:971-236-4445
Practice Address - Street 1:7150 SW HAMPTON ST STE 101
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8365
Practice Address - Country:US
Practice Address - Phone:971-236-4445
Practice Address - Fax:971-236-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty