Provider Demographics
NPI:1699132829
Name:NATURAL HEALTH SOURCE CLINIC
Entity type:Organization
Organization Name:NATURAL HEALTH SOURCE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATUROPATHIC DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:H
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-855-3475
Mailing Address - Street 1:19300 SW BOONES FERRY RD
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-9086
Mailing Address - Country:US
Mailing Address - Phone:503-855-3475
Mailing Address - Fax:503-855-3948
Practice Address - Street 1:19300 SW BOONES FERRY RD
Practice Address - Street 2:SUITE 2C
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9086
Practice Address - Country:US
Practice Address - Phone:503-855-3475
Practice Address - Fax:503-855-3948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1634261QM1300X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty