1609824010 NPI number — OREGON HEALTH & SCIENCE UNIVERSITY

Table of content: (NPI 1609824010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609824010 NPI number — OREGON HEALTH & SCIENCE UNIVERSITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OREGON HEALTH & SCIENCE UNIVERSITY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609824010
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2525 SW 3RD AVE STE 245
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97201-4901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-494-8548
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3181 SW SAM JACKSON PARK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97239-3011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-494-8744
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DOLL
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
SR VICE PRESIDENT/CFO
Authorized Official Telephone Number:
503-494-8548

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 141008 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3358801 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 041178 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 041138 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 380009A000000 . This is a "MEDICARE SECTION 1011" identifier . This identifiers is of the category "OTHER".
  • Identifier: 115023200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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