Provider Demographics
NPI:1801945084
Name:PORTLAND RHEUMATOLOGY CLINIC LLC
Entity type:Organization
Organization Name:PORTLAND RHEUMATOLOGY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARKHUIZEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-244-3162
Mailing Address - Street 1:10230 SW CAPITOL HWY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-6809
Mailing Address - Country:US
Mailing Address - Phone:503-244-3162
Mailing Address - Fax:503-244-3166
Practice Address - Street 1:10230 SW CAPITOL HWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-6809
Practice Address - Country:US
Practice Address - Phone:503-244-3162
Practice Address - Fax:503-244-3166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20458207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G02321Medicare UPIN
R134141Medicare ID - Type Unspecified