1. Home
  2. Directory
  3. Oregon
  4. Lake Oswego
  5. Otolaryngology
  6. NPI Profile

LAKE GROVE ENT PC
NPI 1043211824
Otolaryngology in Lake Oswego, OR

Active since August 03, 2005
17704 JEAN WAY, STE 101, LAKE OSWEGO, OR 97035(503) 699-0370(971) 236-9099 Get Directions Write a Review

NPPES record last updated: April 4, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Lake Grove Ent Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKE GROVE ENT PC (NPI 1043211824) is a healthcare organization registered as an otolaryngology in Lake Oswego, Oregon and active in the NPI registry since August 2005. The organization lists Cheryl Lee Kruse, Clinic Manager, as its authorized official.

NPPES Registry Identity

NPI1043211824
Entity TypeOrganization
Primary Taxonomy207Y00000X
Legal Business NameLAKE GROVE ENT PC
Location Address17704 JEAN WAY, STE 101Lake Oswego, OR 97035-5497
Mailing Address17704 Jean Way, Ste 101Lake Oswego, OR 97035-5497 · (503) 699-0370 · Fax (971) 236-9099
Phone(503) 699-0370
Fax(971) 236-9099
Organization SubpartNo
Authorized OfficialCheryl Lee KruseClinic Manager · (503) 699-0370
Enumeration DateAugust 3, 2005
Last NPPES UpdateApril 4, 2022
NPPES CertifiedApril 4, 2022
✔ NPI 1043211824 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOtolaryngologyAllopathic & Osteopathic Physicians
Taxonomy Code207Y00000X
Definition
An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise.
17704 JEAN WAY, Lake Oswego, OR 97035
Open in Google Maps ↗

Other Identifiers 1

Medicaid005809OR

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Providence Health Plan, Regence BlueCross BlueShield of Oregon.Insurance ›

Other Providers at the Same Location NPPES 18

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KRISTINA E HARP M.D P.C
Internal Medicine
17704 JEAN WAY, SUITE 105
LAKE OSWEGO, OR 97035
Clackamas County (503) 675-6776
MS. LUCINDA ANN BALLAS ANP
Nurse Practitioner (Adult Health)
17704 JEAN WAY, 105
LAKE OSWEGO, OR 97035
Clackamas County (503) 675-6776
WESTLAKE INTERNAL MEDICINE, LLC
Internal Medicine
17704 JEAN WAY, SUITE 105
LAKE OSWEGO, OR 97035
Clackamas County (503) 675-6776
MAUREEN M MULCAHY M.D.
Otolaryngology (Otology & Neurotology)
17704 JEAN WAY
LAKE OSWEGO, OR 97035
Clackamas County (503) 699-0370
MR. SCOT SHOICHI ITOMURA PA-C
Physician Assistant
17704 JEAN WAY, STE 101
LAKE OSWEGO, OR 97035
Clackamas County (503) 699-0370
ANDREW E PITT MD
Dermatology
17704 JEAN WAY, SUITE 102
LAKE OSWEGO, OR 97035
Clackamas County (503) 635-9221
ROBERT H FURMAN MD
Otolaryngology
17704 JEAN WAY, STE 101
LAKE OSWEGO, OR 97035
Clackamas County (503) 699-0370
SUE A LEWIS MD
Internal Medicine
17704 JEAN WAY, STE 105
LAKE OSWEGO, OR 97035
Clackamas County (503) 675-6776

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lake Grove Ent PC's NPI number?

The NPI number for Lake Grove Ent PC is 1043211824. It was assigned to this organization in the NPPES registry on August 3, 2005.

Where is Lake Grove Ent PC located?

Lake Grove Ent PC is located at 17704 Jean Way Ste 101, Lake Oswego, OR 97035. The listed phone number is (503) 699-0370.

What is Lake Grove Ent PC's specialty?

The primary specialty registered for this NPI is Otolaryngology with taxonomy code 207Y00000X.

What insurance does Lake Grove Ent PC accept?

Health plans from BridgeSpan Health Company, Providence Health Plan and Regence BlueCross BlueShield of Oregon list Lake Grove Ent PC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Lake Grove Ent PC was last updated on April 4, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.