| Maple Street Clinic, PC | |
|
1825 Maple St Forest Grove OR 97116-1939 | |
| (503) 357-2136 | |
| (503) 359-5479 |
| Full Name | Maple Street Clinic, PC |
|---|---|
| Speciality | Family Medicine |
| Location | 1825 Maple St, Forest Grove, Oregon |
| Authorized Official Name and Position | John Dahlquist (CLINIC ADMINISTRATOR) |
| Authorized Official Contact | 5033572136 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Maple Street Clinic, PC 1825 Maple St Forest Grove OR 97116-1939 Ph: (503) 357-2136 | Maple Street Clinic, PC 1825 Maple St Forest Grove OR 97116-1939 Ph: (503) 357-2136 |
| NPI Number | 1225066194 |
|---|---|
| Provider Enumeration Date | 06/29/2006 |
| Last Update Date | 01/10/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225066194 | NPI | - | NPPES |
| R0000WCBCC | Other | OR | MEDICARE PTIN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
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