Provider Demographics
NPI:1043045388
Name:SR CLINIC
Entity type:Organization
Organization Name:SR CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMESON
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:DTCM
Authorized Official - Phone:646-623-9057
Mailing Address - Street 1:4246 SE BELMONT ST STE 5
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1676
Mailing Address - Country:US
Mailing Address - Phone:503-445-8114
Mailing Address - Fax:
Practice Address - Street 1:4246 SE BELMONT ST STE 5
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1676
Practice Address - Country:US
Practice Address - Phone:503-445-8114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty