| Organization Name: | CANBY HEALTHCARE CLINIC LLC |
| NPI Number: | 1114253713 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PAULINE L RICHARDS (OWNER) |
| Mailing Address: | 703 Se 1st Ave Canby |
| State: | OR US |
| Postal Code: | 970133849 |
| Phone Number: | 5032667686 |
| Fax Number: | 5032667382 |
| NPI Enumeration Date: | 11/02/2009 |
| NPI Last Update Date: | 02/14/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207QA0505X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Family Medicine |
| Taxonomy Specialization: | Adult Medicine |
| Taxonomy Definition: | |