1912549791 NPI number — OREGON PATIENT CARE COORDINATORS

Table of content: (NPI 1912549791)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912549791 NPI number — OREGON PATIENT CARE COORDINATORS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OREGON PATIENT CARE COORDINATORS
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:
1912549791
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
77 SW RIVERVIEW PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRESHAM
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97080-6773
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-875-1922
Provider Business Mailing Address Fax Number:
503-749-7599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77 SW RIVERVIEW PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRESHAM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97080-6773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-875-1922
Provider Business Practice Location Address Fax Number:
503-749-7599
Provider Enumeration Date:
10/12/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
CRYSTAL
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
503-875-1922

Provider Taxonomy Codes

  • Taxonomy code: 2279P1004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2279P1005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1326698143 . This is a "NPPES" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".