1902062672 NPI number — COLUMBIA LUTHERAN CHARITIES

Table of content: (NPI 1902062672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902062672 NPI number — COLUMBIA LUTHERAN CHARITIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLUMBIA LUTHERAN CHARITIES
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:
CMH UROLOGY CLINIC
Provider Other Organization Name Type Code:
5
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:
1902062672
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2111 EXCHANGE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASTORIA
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97103-3329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-325-4321
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2120 EXCHANGE ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
ASTORIA
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97103-3365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-325-7888
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/01/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
THORSEN
Authorized Official First Name:
ERIK
Authorized Official Middle Name:
W
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
503-325-4321

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  141146 , 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)