WILLAMETTE VALLEY IMMUNOLOGY CENTER PC (NPI# 1952622508) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952622508 |
| Entity Type | Organization |
| Organization Name | WILLAMETTE VALLEY IMMUNOLOGY CENTER PC |
| Practice Address |
169 Ne 102nd Ave Portland OR 97220-4169 |
| Practice Telephone | 5032627273 |
| Practice Fax Number | 5032627274 |
| Mailing Telephone | 5032627273 |
| Mailing Fax Number | 5032627274 |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2010-06-17 |
| Authorized Official Name | DR. THOMAS JEFFERSON SADDORIS II (PHYSICIAN OWNER) |
| Authorized Official Telephone | 5032627273 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | MD10197 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 18374 | 05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | WILLAMETTE VALLEY IMMUNOLOGY CENTER PC | 129 Ne 102nd Ave Ste A, Portland, OR 97220 |
| Street Address |
169 NE 102ND AVE |
| City | PORTLAND |
| State | OR |
| Zip Code | 97220-4169 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376632356 | Thomas Jefferson Saddoris II | Internal Medicine | 169 Ne 102nd Ave, Portland, OR 97220-4169 | 2006-10-11 |
| 1558997502 | Lags Spine and Sportscare Medical Centers, Inc. | Durable Medical Equipment & Medical Supplies | 169 Ne 102nd Ave, Portland, OR 97220-4169 | 2020-03-20 |
| 1982101143 | Lags Spine and Sportscare Medical Centers, Inc. | Physical Medicine & Rehabilitation | 169 Ne 102nd Ave, Portland, OR 97220-4169 | 2018-04-12 |
| 1316468127 | Lags Spine and Sportscare Medical Centers, Inc. | Counselor | 169 Ne 102nd Ave, Portland, OR 97220-4169 | 2017-06-30 |
| 1013302223 | Lags Medical Centers, Or, P.C. | Physical Medicine & Rehabilitation | 169 Ne 102nd Ave, Portland, OR 97220-4169 | 2015-04-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316569254 | Debra Shamblin | Behavioral Analyst | 150 Ne 100th Ave, Portland, OR 97220 | 2020-05-14 |
| 1336780618 | Joan Lambert | Technician | 2802 Ne 108th Avenue, Portland, OR 97220 | 2019-10-08 |
| 1750933917 | Multnomah County | Clinic/Center | 11540 Ne Inverness Dr., Inverness Jail, Portland, OR 97220 | 2019-07-09 |
| 1194223107 | Landmark Connect of Oregon PC | General Practice | 5933 Ne Win Sivers Dr Ste 310, Portland, OR 97220 | 2018-01-24 |
| 1487178711 | Andrew Shonk | Massage Therapist | 163 Ne 102nd Ave Blid V, Portland, OR 97220 | 2017-07-28 |
| 1548781693 | Greater New Hope Family Services | Lodging | 11868 Ne Sandy Blvd, Portland, OR 97220 | 2017-06-29 |
| 1245771740 | Maria Teresa Banez Salcedo | Registered Nurse | 10300 Ne Hancock Street, Portland, OR 97220 | 2017-03-16 |
| 1568901858 | Christopher Gabriel Lyons | Adult Companion | 1343 Ne 118 Ave. Apt5, Portland, OR 97220 | 2017-02-20 |
| 1962945956 | Linda Ann Oldenburg | Registered Nurse | 9515 Ne Skidmore Avenue, Portland, OR 97220 | 2016-11-23 |
| 1326493446 | Trent D. Wilson | Massage Therapist | 8401 Ne Halsey St., Suite 101, Portland, OR 97220 | 2016-04-26 |
| Find all providers in zip 97220 | ||||
| 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 |
|---|---|---|---|---|
| 1770107302 | Vpa PC | Internal Medicine | 1500 Ne 15th Ave Apt 431, Portland, OR 97232-4418 | 2020-05-29 |
| 1073167730 | Oregon Adult Medicine PC | Internal Medicine | 2330 Nw Flanders St Ste 201, Portland, OR 97210-3460 | 2019-07-30 |
| 1265889265 | Jared Tobolski | Internal Medicine | 22 Bramhall St Dept Of, Portland, ME 04102-3175 | 2016-05-19 |
| 1528421039 | Celine Haotian Zhou | Internal Medicine | 3181 Sw Sam Jackson Park Rd, L-579, Ohsu, Portland, OR 97239 | 2016-04-01 |
| 1043685407 | Michael David Fox | Internal Medicine | 1015 Nw 22nd Ave # 230, Portland, OR 97210-3025 | 2015-12-09 |
| 1134516701 | Anne Longtine | Internal Medicine | 65 Waterville St, Portland, ME 04101 | 2015-04-22 |
| 1184016099 | Wendy W Yu | Internal Medicine | 9135 Sw Barnes Rd Ste 763, Portland, OR 97225-6777 | 2015-03-02 |
| 1639586191 | Stefan Christison | Internal Medicine | 1120 Nw 20th Ave Ste 110, Portland, OR 97209-1591 | 2014-07-16 |
| 1336551555 | Lee Michael Anthony | Internal Medicine | 9205 Sw Barnes Rd Mt-2800, Portland, OR 97225-6603 | 2014-05-22 |
| 1558772889 | Kyaw Zin Thein | Internal Medicine | 3485 S Bond Ave, Portland, OR 97239-4503 | 2014-05-08 |
| 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.