Organization Name: | GLADSTONE COMMUNITY CLINIC |
NPI Number: | 1063713717 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | HANNAH E TYLER (R.N.) |
Mailing Address: | 18911 Portland Ave Gladstone |
State: | OR US |
Postal Code: | 970271630 |
Phone Number: | 5038504472 |
Fax Number: | 5038504473 |
NPI Enumeration Date: | 11/11/2010 |
NPI Last Update Date: | 11/11/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QC1500X |
License Number: | 200243005RN |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Community Health |
Taxonomy Definition: |