LAKE GROVE FAMILY MEDICAL CLINIC LLC (NPI# 1366982258) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366982258 |
| Entity Type | Organization |
| Organization Name | LAKE GROVE FAMILY MEDICAL CLINIC LLC |
| Practice Address |
16463 Boones Ferry Rd Suite 100 Lake Oswego OR 97035-4259 |
| Practice Telephone | 5036351350 |
| Practice Fax Number | 5036358470 |
| Mailing Telephone | 5036351350 |
| Mailing Fax Number | 5036358470 |
| Enumeration Date | 2017-02-27 |
| Last Update Date | 2020-11-03 |
| Authorized Official Name | SHANNON K SABINS (ASSISTANT CLINIC MANAGER) |
| Authorized Official Telephone | 5036351350 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities | ||
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
DO14260 | OR | Ambulatory Health Care Facilities |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | LAKE GROVE FAMILY MEDICAL CLINIC LLC | 16463 Boones Ferry Rd Ste 100, Lake Oswego, OR 97035 |
| Street Address |
16463 BOONES FERRY RD SUITE 100 |
| City | LAKE OSWEGO |
| State | OR |
| Zip Code | 97035-4259 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720069529 | Lauren Marlene Gearhart | Internal Medicine | 16463 Boones Ferry Rd, Lake Oswego, OR 97035-4207 | 2005-11-09 |
| 1528429198 | The Rhythm Clinic LLC | Internal Medicine | 16463 Boones Ferry Rd, Lake Oswego, OR 97035-4259 | 2016-03-10 |
| 1588902902 | Olson Pediatric Clinic, LLC | Pediatrics | 16463 Boones Ferry Rd, Suite 400, Lake Oswego, OR 97035-4259 | 2013-01-18 |
| 1639438419 | Janice Modesitt Lmt | Clinic/Center | 16463 Boones Ferry Rd, Ste. 100, Lake Oswego, OR 97035-4259 | 2012-05-14 |
| 1619273844 | Northwest Endocrinology, LLC | Internal Medicine | 16463 Boones Ferry Rd, Suite 300, Lake Oswego, OR 97035-4259 | 2011-02-05 |
| 1558505032 | Elizabeth Graff | Pediatrics | 16463 Boones Ferry Rd, Suite 400, Lake Oswego, OR 97035-4259 | 2009-04-28 |
| 1295978732 | Steven A. Hashiguchi, Md, LLC | Internal Medicine | 16463 Boones Ferry Rd, #300, Lake Oswego, OR 97035-4259 | 2009-04-14 |
| 1992841555 | Janice Carole Modesitt | Specialist | 16463 Boones Ferry Rd, Lake Oswego, OR 97035-4259 | 2007-01-30 |
| 1780796961 | Meri Todd Harper | Pediatrics | 16463 Boones Ferry Rd, Suite 400, Lake Oswego, OR 97035-4259 | 2006-08-31 |
| 1912930074 | Claudia Marie Sage | Dietitian, Registered | 16463 Boones Ferry Rd, Suite 100, Lake Oswego, OR 97035-4259 | 2006-07-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932700127 | Teresa Siebenaler Scott | Social Worker | 3990 Sw Collins Way, Suite 202, Lake Owsego, OR 97035 | 2020-11-04 |
| 1528671567 | Martin Henry Lees | Internal Medicine | 14 Morningview Lane, Lake Oswego, OR 97035 | 2020-08-28 |
| 1356976187 | Premere Rehab LLC | Occupational Therapist | Infinity Rehab - The Springs At Lake Oswego, 3900 Kruse Way Pl, Lake Oswego, OR 97035 | 2020-03-12 |
| 1689212193 | Jennifer Chauvin | Nurse Practitioner | 20 Juarez Street, Lake Oswego, OR 97035 | 2019-12-16 |
| 1003396888 | Sarah Guenzburger | Physical Therapist | 3900 Kruse Way Pl, Lake Oswego, OR 97035 | 2018-08-21 |
| 1568964252 | Brett Johnson | Marriage & Family Therapist | 5655 Southwood Dr, Lake Oswego, OR 97035 | 2018-03-08 |
| 1912416561 | Michael Paul Long | Social Worker | 14523 Westlake Drive, Lake Oswego, Or 97035, Lake Oswego, OR 97035 | 2017-09-27 |
| 1467807859 | Misty Lohn | Nurse Practitioner | 5 Centerpointe Dr., Ste 600, Lake Oswego, OR 97035 | 2016-05-04 |
| 1326405473 | Kelsey Prince | Behavioral Analyst | 6400 Sw Rosewood St., Portland (lake Oswego), OR 97035 | 2016-01-20 |
| 1942683388 | Elizabeth Risberg Harrison | Massage Therapist | 190 Oswego Summit, Lake Oswego, OR 97035 | 2015-07-02 |
| Find all providers in zip 97035 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568805414 | Healthy Life Centre for Wellness | Clinic/Center | 4309 Oakridge Rd, Lake Oswego, OR 97035-3418 | 2013-04-10 |
| 1043516289 | Dr Pepel Family Practice | Clinic/Center | 15880 Quarry Rd, Lake Oswego, OR 97035-3336 | 2011-02-06 |
| 1255502928 | Marion J Darling Mdpc | Clinic/Center | 16699 Boones Ferry Rd, Ste 210, Lake Oswego, OR 97035-4366 | 2008-03-20 |
| 1255501698 | Kenneth P Melvin, Md, PC | Clinic/Center | 4035 Mercantile Dr, Suite 112, Lake Oswego, OR 97035-2546 | 2008-02-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376158774 | G&h Healthcare Inc | Clinic/Center | 17022 Sw Pacific Hwy Apt 210, Tigard, OR 97224-3400 | 2020-09-11 |
| 1750906509 | Alpha Care Family Medicine | Clinic/Center | 14455 Sw Allen Blvd Ste 100, Beaverton, OR 97005-4428 | 2020-06-08 |
| 1104447895 | Beyond Health LLC | Clinic/Center | 6440 Nw Mcmullen Ave, Portland, OR 97229-1158 | 2020-05-04 |
| 1851942536 | Careatc | Clinic/Center | 1101 W Main St Ste 103, Medford, OR 97501-2966 | 2019-09-24 |
| 1871153585 | Full Bloom Natural Medicine, LLC | Clinic/Center | 922 Nw Circle Blvd Ste 180, Corvallis, OR 97330-1483 | 2019-06-14 |
| 1831757475 | Structural Solutions Chiropractic | Clinic/Center | 121 Nw Everett St, Portland, OR 97209-4049 | 2019-05-29 |
| 1770147357 | Uptown Providers PC | Clinic/Center | 397 Warner Milne Rd, Oregon City, OR 97045-4045 | 2019-04-29 |
| 1720549058 | Barbara Gilbertson, Do, Inc. | Clinic/Center | 1803b Main St, Klamath Falls, OR 97601-2636 | 2019-03-28 |
| 1033674841 | Jeremy Mikolai Nd Inc | Clinic/Center | 2540 Ne M L King Blvd, Portland, OR 97212-3732 | 2019-02-06 |
| 1326531666 | Working Class Medicine LLC | Clinic/Center | 2133 N. Willis Blvd, Studio D, Portland, OR 97217 | 2018-06-12 |
| Find all providers with the same taxonomy | ||||
| City | LAKE OSWEGO |
| Zip Code | 97035 |
Please comment or provide details below to improve the information on LAKE GROVE FAMILY MEDICAL CLINIC LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.