MIRANDA MCCORMACK M.D. LLC NPI 1043488166

NPI Information

NPI: 1043488166
Provider Name: MIRANDA MCCORMACK, M.D., LLC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 38D1078738

Address:
5040 SW GRIFFITH DR
#201
BEAVERTON, OR
ZIP 97005
Phone: (503) 616-2224
Get Directions

MIRANDA MCCORMACK, M.D., LLC is a primary care clinic center in Beaverton, OR. MIRANDA MCCORMACK, M.D., LLC NPI is 1043488166. The provider is registered as an organization entity type.

The provider's business location address is:

5040 SW GRIFFITH DR
#201
BEAVERTON, OR
ZIP 97005-985
Phone: (503) 616-2224

The provider's authorized official is Miranda Christie Mccormack .
The authorized official title is Physician/owner and has the following contact phone number (503) 616-2224.

The CLIA number assigned to this NPI record is 38D1078738 - tissue bank/repositories with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/11/2008 and was last updated on 2/11/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care	465592-90	OREGON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	H73664	MEDICARE UPIN	OREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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