1073054714 NPI number — UNIVERSITY PROFESSIONAL SERVICES

Table of content: (NPI 1073054714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073054714 NPI number — UNIVERSITY PROFESSIONAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY PROFESSIONAL SERVICES
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:
OHSU HOME INFUSION PHARMACY
Provider Other Organization Name Type Code:
3
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:
1073054714
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 SW 5TH AVE STE 500
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:
97201-5537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-494-8417
Provider Business Mailing Address Fax Number:
503-346-8015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9317 SW NIMBUS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAVERTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-346-3850
Provider Business Practice Location Address Fax Number:
503-346-3851
Provider Enumeration Date:
03/14/2017

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT, ERC
Authorized Official Telephone Number:
503-494-8417

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WI0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: RP-0003214-CS , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: RP-0003214-CS , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336H0001X , with the licence number: RP-0003214-CS , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7649620001 . This is a "MEDICARE NSC" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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