Provider Demographics
NPI:1871745570
Name:CHEHALEM VALLEY FOOT CLINIC, PC
Entity type:Organization
Organization Name:CHEHALEM VALLEY FOOT CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LIPE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:503-538-0800
Mailing Address - Street 1:201 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-2727
Mailing Address - Country:US
Mailing Address - Phone:503-538-0800
Mailing Address - Fax:503-554-8408
Practice Address - Street 1:201 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2727
Practice Address - Country:US
Practice Address - Phone:503-538-0800
Practice Address - Fax:503-554-8408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00180213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORT67854Medicare UPIN