THE MEDICAL WELLNESS CLINIC, LLC (NPI# 1295922755) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295922755 |
| Entity Type | Organization |
| Organization Name | THE MEDICAL WELLNESS CLINIC, LLC |
| Practice Address |
4035 Mercantile Dr Suite 101 Lake Oswego OR 97035-2546 |
| Practice Telephone | 5036973001 |
| Practice Fax Number | 5036970906 |
| Mailing Telephone | 5036973001 |
| Mailing Fax Number | 5036970906 |
| Enumeration Date | 2007-09-28 |
| Last Update Date | 2007-09-28 |
| Authorized Official Name | STEPHEN A WEIL (CLINIC DIRECTOR) |
| Authorized Official Telephone | 5036973001 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | MD07794 | OR | Allopathic & Osteopathic Physicians |
| Street Address |
4035 MERCANTILE DR SUITE 101 |
| City | LAKE OSWEGO |
| State | OR |
| Zip Code | 97035-2546 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760466015 | Shari L Mace | Optometrist | 4035 Mercantile Dr, Suite 216, Lake Oswego, OR 97035-2546 | 2005-11-30 |
| 1275085680 | Jeffrey Eric Mcnally | Chiropractor | 4035 Mercantile Dr, #112, Lake Oswego, OR 97035-2546 | 2016-11-02 |
| 1154749547 | Erik William Reis | Chiropractor | 4035 Mercantile Dr, 112, Lake Oswego, OR 97035-2546 | 2014-04-02 |
| 1093978835 | Lake Oswego Family Physicians | Family Medicine | 4035 Mercantile Dr, Suite 104, Lake Oswego, OR 97035-2546 | 2008-07-02 |
| 1538333042 | Glen Zielinski, Dc, PC | Chiropractor | 4035 Mercantile Dr, Suite 112, Lake Oswego, OR 97035-2546 | 2008-04-15 |
| 1255501698 | Kenneth P Melvin, Md, PC | Clinic/Center | 4035 Mercantile Dr, Suite 112, Lake Oswego, OR 97035-2546 | 2008-02-29 |
| 1942401351 | Donna Lianne Jackson | Physical Therapist | 4035 Mercantile Dr, Suite 108, Lake Oswego, OR 97035-2546 | 2007-05-31 |
| 1992832851 | Lee David Robinson | Specialist | 4035 Mercantile Dr, Suite 206, Lake Oswego, OR 97035-2546 | 2007-02-27 |
| 1811008170 | David Robert Burton | Dentist | 4035 Mercantile Dr, Suite 100, Lake Oswego, OR 97035-2546 | 2006-08-31 |
| 1205853256 | Dr. Paula D Kilpatrick | Internal Medicine | 4035 Mercantile Dr, Suite 101, Lake Oswego, OR 97035-2546 | 2006-07-16 |
| 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 | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528671567 | Martin Henry Lees | Internal Medicine | 14 Morningview Lane, Lake Oswego, OR 97035 | 2020-08-28 |
| 1013302348 | Jonathan Hattenhauer | Internal Medicine | 891 G Ave, Lake Oswego, OR 97034-2258 | 2015-04-03 |
| 1477714491 | Jay Paul Douglass | Internal Medicine | 16463 Boones Ferry Rd Ste 300, Lake Oswego, OR 97035-4376 | 2008-06-23 |
| 1861400772 | Andrew Ross Harbison | Internal Medicine | 17704 Jean Way Ste 105, Lake Oswego, OR 97035-5586 | 2006-08-04 |
| 1396766796 | Edward Everett Conrad Jr. | Internal Medicine | 550 3rd St, Lake Oswego, OR 97034-3002 | 2006-07-21 |
| 1770519340 | Hidenao Kimura | Internal Medicine | 16463 Boones Ferry Rd 300, Lake Oswego, OR 97035 | 2006-06-24 |
| 1447201215 | Stephen Alan Weil | Internal Medicine | 4035 Sw Mercantile Dr, Ste 101, Lake Oswego, OR 97035 | 2006-05-15 |
| 1134179872 | Paula Diane Kilpatrick | Internal Medicine | 4035 Sw Mercantile Drive, Suite 101, Lake Oswego, OR 97035-2587 | 2006-05-11 |
| 1962469551 | H Freeman Harris | Internal Medicine | 4309 Oakridge Rd, Lake Oswego, OR 97035-3418 | 2006-04-27 |
| 1447216189 | Stephen Robert Enloe | Internal Medicine | 16463 Boones Ferry Rd # 300, Lake Oswego, OR 97035-4259 | 2006-04-21 |
| Find all providers in LAKE OSWEGO | ||||
| City | LAKE OSWEGO |
| Zip Code | 97035 |
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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.