Provider Demographics
NPI:1992942064
Name:LESTER TENGSICO LLC
Entity type:Organization
Organization Name:LESTER TENGSICO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:
Authorized Official - Last Name:TENGSICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-760-5151
Mailing Address - Street 1:PO BOX 33912
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97292-3912
Mailing Address - Country:US
Mailing Address - Phone:503-760-5151
Mailing Address - Fax:503-760-5454
Practice Address - Street 1:10424 SE CHERRY BLOSSOM DR STE F
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2825
Practice Address - Country:US
Practice Address - Phone:503-760-5151
Practice Address - Fax:503-760-5454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00263213E00000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU55898Medicare UPIN