DR. LAURA MELLICK (NPI# 1851354872) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851354872 |
| Entity Type | Individual |
| Full Name | DR. LAURA MELLICK |
| Credential | MD |
| Practice Address |
25 Nw 23rd Pl Suite 11 Portland OR 97210-5580 |
| Mailing Address |
Po Box 5275 Portland OR 97208-5275 |
| Practice Telephone | 5033056262 |
| Practice Fax Number | 5033056078 |
| Mailing Telephone | 8888283196 |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2012-09-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207P00000X | Emergency Medicine | MD17993 | OR | Allopathic & Osteopathic Physicians |
| Y | 208D00000X | General Practice | MD17993 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 057252 | 05 | |
| REGENCE BC/BS | 858543007 | 01 | |
| WA L & I | 208975 | 01 | |
| WA | 8182214 | 05 |
| Street Address |
25 NW 23RD PL SUITE 11 |
| City | PORTLAND |
| State | OR |
| Zip Code | 97210-5580 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457337156 | Lori Lynn Gross | Preventive Medicine | 25 Nw 23rd Pl, Suite 6, #324, Portland, OR 97210-5580 | 2005-12-15 |
| 1386175396 | Kelsey Selene Peterson Wolfe | Emergency Medicine | 25 Nw 23rd Pl, Portland, OR 97210-5580 | 2017-03-22 |
| 1144598293 | Uptown Providers PC | Clinic/Center | 25 Nw 23rd Pl, Ste 11, Portland, OR 97210-5580 | 2011-12-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679109086 | Joseph Francolino | Massage Therapist | 2174 Nw Davis Street, Apartment 105, Portland, OR 97210 | 2020-03-17 |
| 1215574058 | Northwest Dbt LLC | Psychologist | 2230 Nw Pettygrove St., Suite 130, Portland, OR 97210 | 2019-11-27 |
| 1649769480 | Dipesh Patel | Student in an Organized Health Care Education/Training Program | 1200 Nw 23rd Ave. Legacy Clinic Good Samaritan, Portland, OR 97210 | 2018-05-08 |
| 1760987234 | Meghan Teague | Student in an Organized Health Care Education/Training Program | Legacy Good Samaritan Medical Center- Gme, 1015 Nw 22nd Ave, Portland, OR 97210 | 2018-03-27 |
| 1205349172 | Paul M Storm | Acupuncturist | 1708 Nw 25th Ave. Apt. #6, Portland, OR 97210 | 2017-11-14 |
| 1740703750 | Audra K Berning | Massage Therapist | 2122 Nw Quimby, Root Whole Body, Portland, OR 97210 | 2017-07-21 |
| 1720539810 | Anna-marie Elizabeth Wood | Audiologist | 2222 Nw Lovejoy St Ste 662, Portland, OR 97210 | 2016-10-24 |
| 1659829836 | H&s Pearl, LLC | Massage Therapist | 25 Nw 23rd Pl, Suite 7, Portland, OR 97210 | 2016-09-15 |
| 1255785796 | Cortez Natural Medicine, Inc. | Acupuncturist | 2230 Nw Pettygove Street, Unit 130, Portland, OR 97210 | 2016-04-21 |
| 1932563616 | Vincent Chen | Student in an Organized Health Care Education/Training Program | 1200 Nw 23rd Avenue, Legacy Clinic Good Samaritan, Portland, OR 97210 | 2016-04-08 |
| Find all providers in zip 97210 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194223107 | Landmark Connect of Oregon PC | General Practice | 5933 Ne Win Sivers Dr Ste 310, Portland, OR 97220 | 2018-01-24 |
| 1346751443 | Providence Health & Services Oregon | General Practice | 4400 Ne Halsey St, Pop 2, 3rd Floor, Portland, OR 97213-1545 | 2017-10-16 |
| 1336697143 | Rita Lawler | General Practice | 8353 Se Clatsop Ct, Portland, OR 97266-6159 | 2016-09-21 |
| 1235526849 | Hollis Lule Augee | General Practice | 5151 S.w. 88th Ave., Portland, OR 97225-1717 | 2015-04-21 |
| 1093134496 | Red Leaf Natural Health Clinic | General Practice | 833 Sw 11th Ave Ste 1018, Portland, OR 97205-2124 | 2014-04-14 |
| 1861770190 | Jeffrey Owen Pentecost | General Practice | 3574 Se Harold Ct, Portland, OR 97202-4344 | 2011-08-03 |
| 1255651592 | Nic Group Inc | General Practice | 8383 Ne Sandy Blvd Ste 320dd, Portland, OR 97220-4968 | 2010-06-09 |
| 1619296985 | Thcf | General Practice | 105 Se 18th Ave, Portland, OR 97214-1559 | 2010-05-25 |
| 1518106640 | Keith C Klopfer | General Practice | 1601 Sw Pendleton St, Portland, OR 97239-2619 | 2009-02-12 |
| 1275793424 | Harriet Cooke | General Practice | 2929 Sw Multnomah Blvd Ste 301, Portland, OR 97219-4072 | 2008-06-11 |
| Find all providers in PORTLAND | ||||
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| 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.