SOUTH TABOR FAMILY PHYSICIANS
NPI 1982649299
Clinic/Center in Portland, OR

Q: What is South Tabor Family Physicians's NPI number?

The NPI number for South Tabor Family Physicians is 1982649299. It was assigned to this organization in the NPPES registry on June 19, 2006.

Q: What is South Tabor Family Physicians's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Active since June 19, 2006CLIA 38D0623570 · Accreditation

10803 SE CHERRY BLOSSOM DR, PORTLAND, OR 97216(503) 261-7200(503) 261-7249 Get Directions Write a Review

NPPES record last updated: October 3, 2012. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About South Tabor Family Physicians NPPES

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

SOUTH TABOR FAMILY PHYSICIANS (NPI 1982649299) is a healthcare organization registered as a clinic/center in Portland, Oregon and active in the NPI registry since June 2006. The organization holds an CLIA Accreditation certificate valid through October 9, 2026 and lists Londa Everett, Administrator, as its authorized official.

NPPES Registry Identity

NPI1982649299

Entity TypeOrganization

Primary Taxonomy261Q00000X

Legal Business NameSOUTH TABOR FAMILY PHYSICIANS

Location Address10803 SE CHERRY BLOSSOM DRPortland, OR 97216-3107

Mailing Address10803 Se Cherry Blossom DrPortland, OR 97216-3107 · (503) 261-7200 · Fax (503) 261-7249

Phone(503) 261-7200

Fax(503) 261-7249

Organization SubpartNo

Authorized OfficialLonda EverettAdministrator · (503) 261-7200

Enumeration DateJune 19, 2006

Last NPPES UpdateOctober 3, 2012

✔ NPI 1982649299 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities

Taxonomy Code261Q00000X

License✔ Licensed in OR · 262417

Definition

A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

10803 SE CHERRY BLOSSOM DR, Portland, OR 97216

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Other Identifiers 1

Medicare ID-Type Unspecified00WCBBROR

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Moda Health Plan, Inc., Providence Health Plan and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Accreditation 38D0623570

South Tabor Family Physicians · Portland, OR

Active · expires Oct 9, 2026

CLIA Number38D0623570

Laboratory TypePhysician Office

Certificate Effective DateOctober 10, 2024

Certificate Expiration DateOctober 9, 2026

Laboratory DirectorDr. William B. Bronec

Laboratory Phone(503) 261-7216

Laboratory LocationSouth Tabor Family Physicians10803 SE Cherry Blossom Dr, Portland, OR 97216

CLIA data matches this NPI record on: Address Name

This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

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.

DR. TIMOTHY P JANZEN M.D.

Family Medicine