Provider Demographics
NPI:1023695830
Name:MELIORA CLINIC
Entity type:Organization
Organization Name:MELIORA CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BOBBIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:LAWTON LAMICHHANE
Authorized Official - Suffix:
Authorized Official - Credentials:CMOM
Authorized Official - Phone:971-220-2759
Mailing Address - Street 1:2540 NE MLK JR BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212
Mailing Address - Country:US
Mailing Address - Phone:971-220-2759
Mailing Address - Fax:503-954-2250
Practice Address - Street 1:2540 NE MLK JR BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212
Practice Address - Country:US
Practice Address - Phone:971-220-2759
Practice Address - Fax:503-954-2250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-26
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500798461Medicaid