1467425629 NPI number — DR. STEVEN A WAHLS MD

Table of content: MORGAN JANE STALDER DO (NPI 1124648415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467425629 NPI number — DR. STEVEN A WAHLS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WAHLS
Provider First Name:
STEVEN
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1467425629
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
51377 SW OLD PORTLAND RD STE C
Provider Second Line Business Mailing Address:
OHSU FAMILY MEDICINE AT SCAPPOOSE
Provider Business Mailing Address City Name:
SCAPPOOSE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97056-4023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-418-4222
Provider Business Mailing Address Fax Number:
503-418-4223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
51377 SW OLD PORTLAND RD STE C
Provider Second Line Business Practice Location Address:
OHSU FAMILY MEDICINE AT SCAPPOOSE
Provider Business Practice Location Address City Name:
SCAPPOOSE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97056-4023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-418-4222
Provider Business Practice Location Address Fax Number:
503-418-4223
Provider Enumeration Date:
02/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD13885 , 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: 080122426 . This is a "IND RAILROAD" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 115741 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: J406418 . This is a "IND PACSOURCE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 00188007 . This is a "IND BLUE CROSS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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