KPG OREGON, LLC (NPI# 1730552845) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730552845 |
| Entity Type | Organization |
| Organization Name | KPG OREGON, LLC |
| Practice Address |
486 12th Street #200 Astoria OR 97103 |
| Mailing Address |
9000 Sunset Blvd #1500 West Hollywood CA 90069 |
| Practice Telephone | 3109751428 |
| Mailing Telephone | 3109751428 |
| Enumeration Date | 2015-11-11 |
| Last Update Date | 2018-04-12 |
| Authorized Official Name | DARRYL OLIVIER (COO) |
| Authorized Official Telephone | 3109751450 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RA0401X |
Internal Medicine Specialization: Addiction Medicine |
MD168198 | OR | Allopathic & Osteopathic Physicians |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | KPG OREGON, LLC | C/o White Rabbit Partners, 9000 W Sunset Blvd Ste 1500, West Hollywood, CA 90069 |
| Street Address |
486 12TH STREET #200 |
| City | ASTORIA |
| State | OR |
| Zip Code | 97103 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205239043 | Brittany Dawn Vigoren | Dental Hygienist | 433 30th St., Astoria, OR 97103 | 2014-10-08 |
| 1497188858 | Jennifer U Boggs | Counselor | 10 Pier 1 Ste 203, Astoria, OR 97103 | 2013-08-20 |
| 1780022046 | Judy J Curnow | Massage Therapist | 1 12th Street Suite 10, Astoria, OR 97103 | 2013-06-10 |
| 1659626612 | Megan Lampson | Physical Therapist | 646 16th Ave., Astoria, OR 97103 | 2012-07-16 |
| 1043580947 | Matthew Thomas Cassity | Physical Therapy Assistant | 646 16th St., Astoria, OR 97103 | 2012-01-09 |
| 1881975969 | Rebecca Nicole Roe | Contractor | 25 Whitebush Way, Astoria, OR 97103 | 2011-09-02 |
| 1346542214 | Michele Lynn Hart | Social Worker | 2120 Exchange, Astoria, OR 97103 | 2010-11-29 |
| 1447551197 | Barbara Ellen Arnold | Pharmacist | 3250 Leif Erickson Dr, Astoria, OR 97103 | 2010-11-11 |
| 1083915219 | Christina Louise Jones | Pharmacist | 3250 Lief Erickson Dr, Astoria, OR 97103 | 2010-11-04 |
| 1700118585 | Rebecca Ann Hart | Massage Therapist | 2935 Marine Dr Ste. B, Astoria, OR 97103 | 2010-02-04 |
| Find all providers in zip 97103 | ||||
| Taxonomy Code | 207RA0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Addiction Medicine |
| An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205341617 | Mid-valley Healthcare Inc | Internal Medicine | 111 N Main St Ste A, Lebanon, OR 97355-2869 | 2017-12-07 |
| 1366953861 | Ortc, LLC | Internal Medicine | 155 Ne Revere Ave Ste 150, Bend, OR 97701-4147 | 2017-10-24 |
| 1619333259 | Bhs Physician Services of Oregon PC | Internal Medicine | 601 Sw 2nd Ave Ste 2100, Portland, OR 97204-3158 | 2016-01-12 |
| 1316948862 | Richard Hindmarsh | Internal Medicine | 100 Mullins Dr Ste C1, Lebanon, OR 97355-2868 | 2005-08-09 |
| 1568625788 | William Barbee Mitchell | Internal Medicine | 715 Lincoln St, Eugene, OR 97401-2502 | 2008-07-08 |
| 1932129160 | Robert John Naymik | Internal Medicine | 8495 Crater Lake Hwy, White City, OR 97503-3011 | 2006-07-20 |
| 1134145311 | H Kay Wendlandt | Internal Medicine | 17882 Se Mcloughlin Blvd, Milwaukie, OR 97267-6103 | 2006-07-14 |
| 1851335913 | Bruce E. Matthews | Internal Medicine | 100 Mullins Dr Ste C1, Lebanon, OR 97355-2868 | 2006-06-16 |
| 1619967577 | Vern R Williams | Internal Medicine | 15 N Morris St, Portland, OR 97227-1541 | 2005-10-24 |
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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.