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Active NPI 1578776670 Organization (Entity Type 2)

Cheryl C. Tidball Do Pc

General Practice • Gresham, OR

About Cheryl C. Tidball Do Pc NPI 1578776670 Summary

Cheryl C. Tidball Do Pc is a verified healthcare organization specializing in General Practice operating in Gresham, OR. Located at 1217 NE BURNSIDE RD, SUITE 101, this facility provides patient care and medical services under National Provider Identifier (NPI) 1578776670.

Administrative operations and authorized compliance are overseen by Cheryl Tidball (Physician).

The facility is associated with 20 linked healthcare practitioners providing clinical services.

Facility Location & Contact Primary Location

Facility Address

1217 Ne Burnside Rd
Suite 101

Gresham, OR 970306722

Telephone 5034890663
Fax 5036665644

Authorized Official Information

Authorized Contact Name

DR. Cheryl Tidball , D.O.

Title / Role

Physician

Official Telephone

5034890663

Facility Classifications & Specialties

General Practice Primary Taxonomy

NUCC Taxonomy Code: 208D00000X

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

Affiliated Practitioners & Clinicians

Healthcare professionals and specialists practicing at this facility or affiliated group locations

20 Linked

Massage Therapist

Gresham, OR

View Practitioner Profile →
Shayna Carter , MA NPI 1114172285

Counselor - Professional

Gresham, OR

View Practitioner Profile →

Social Worker - Clinical

Gresham, OR

View Practitioner Profile →

Psychologist - Clinical

Gresham, OR

View Practitioner Profile →

Dentist - General Practice

Gresham, OR

View Practitioner Profile →

Social Worker - Clinical

Gresham, OR

View Practitioner Profile →

Facility & Registry History Timeline

Chronological log of verified NPI organization updates, branch relocations, and registry updates

6 Historical Events
NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 1217 NE BURNSIDE RD, SUITE 101, GRESHAM, OR 970306722 (Tel: 5034890663)

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Updated Business Mailing Address July 08, 2007

Registered at 1217 NE BURNSIDE RD, SUITE 101, GRESHAM, OR 970306722 (Tel: 5034890663)

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Organization / Clinic Name Updated July 08, 2007

Operating as CHERYL C. TIDBALL DO PC

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

General Practice (License #DO19432 in OR)

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Initial NPI Registration & Enumeration May 07, 2007

First registered as active Healthcare Organization in NPPES Database.

Patient & Community Reviews

Verified patient ratings, healthcare experiences, and facility photos

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NPI Organization Metadata

NPI Number: 1578776670
Entity Type:
Organization Organization (Hospital, Clinic, Group Practice) (Type 2 NPI)
Enumeration Date: May 07, 2007
Last Update: August 22, 2020

Mailing Address

1217 Ne Burnside Rd, Suite 101

Gresham, OR 970306722

Phone: 5034890663

Public Domain Record This organization profile is sourced from public domain datasets published by CMS and NPPES under FOIA.
⚠️ Medical Disclaimer

Facility details are provided for public information only. In case of a medical emergency, call 911 immediately.