Ancient Fern Medicine

LBN: Ancient Fern Medicine
Ancient Fern Medicine is an health care organization with primary practice located at 2926 Ne Flanders St Ste 2C , Portland OR 97232-3259. The organization recently has only one registered license in Other Service Providers / Acupuncturist, which is considered as the primary health care specialty. Ancient Fern Medicine can be contacted via phone (971) 227-2773, or through Nelson, Timothy Nicholas via phone (971) 227-2773.

Contact Information

Primary practice address
2926 Ne Flanders St Ste 2C Portland OR 97232-3259
Phone: (971) 227-2773
Fax: (971) 275-1961
Website:
Map and Directions
Authorized official contact:
Name: Nelson, Timothy Nicholas Licensed Acupuncturist (LAC)
Phone: (971) 227-2773

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Acupuncturist 171100000X AC161759 Oregon

Profile Details

NPI number 1053763466
LBN Legal business name Ancient Fern Medicine
DBA Doing business as
Authorized official Nelson, Timothy Nicholas Licensed Acupuncturist (LAC)
Entity Organization
Organization subpart 1 No
Enumeration date Jul 8th, 2016
Last updated Jul 8th, 2016 - about 8 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053763466 NPPES
Oregon MEDICAID 500669071
Oregon Other AC161759

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