Jrn Lake O PC
Surgery in Hillsboro, OR. Organization (NPI-2).
NPI number1124416722
StatusActive
Last updated in NPPESDec 15, 2020
Details
- NPI
- 1124416722
- Entity type
- Organization (NPI-2)
- Legal business name
- Jrn Lake O PC
- Organization subpart
- No
- Enumeration date
- Jan 5, 2015
- Certification date
- Dec 15, 2020
- Last updated
- Dec 15, 2020
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208600000X | Surgery | MD25244 | OR | Yes |
Practice location
10690 Ne Cornell Rd Ste 324Hillsboro, OR 97124-9224
Phone 503-297-9340
Mailing address
17050 Pilkington Rd Ste 130Lake Oswego, OR 97035-6308
Phone 503-697-3255 · Fax 503-697-7792
Authorized official
Judith A. Richmond
Owner/President
5035046692
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