Provider Demographics
NPI:1053578484
Name:EASTMORELAND ORTHOPEDIC CLINIC, P.C.
Entity type:Organization
Organization Name:EASTMORELAND ORTHOPEDIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WH
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:503-234-0891
Mailing Address - Street 1:5225 SE 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-4506
Mailing Address - Country:US
Mailing Address - Phone:503-234-0891
Mailing Address - Fax:503-234-4059
Practice Address - Street 1:5225 SE 28TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-4506
Practice Address - Country:US
Practice Address - Phone:503-234-0891
Practice Address - Fax:503-234-4059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO06594207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR004312001OtherREGENCE BLUE CROSS BLUE SHIELD
OR083998Medicaid
E38881Medicare UPIN
OR0000BKWBMMedicare PIN