1922071513 NPI number — DR. JOHN OPPENHEIMER MD

Table of content: DR. JOHN OPPENHEIMER MD (NPI 1922071513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922071513 NPI number — DR. JOHN OPPENHEIMER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OPPENHEIMER
Provider First Name:
JOHN
Provider Middle Name:
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:
1922071513
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1130 NW 22ND AVE #220
Provider Second Line Business Mailing Address:
LEGACY CLINIC NORTHWEST
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97210-3025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-413-8988
Provider Business Mailing Address Fax Number:
503-274-4815

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1130 NW 22ND AVE #220
Provider Second Line Business Practice Location Address:
LEGACY CLINIC NORTHWEST
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97210-3025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-413-8988
Provider Business Practice Location Address Fax Number:
503-274-4815
Provider Enumeration Date:
02/13/2006

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: 207R00000X , with the licence number:  036058549 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0571232 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 143442 . This is a "IHS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 98999 . This is a "BCWELLMARK 7TH ST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 036058549002 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 273137 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8497364 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 98986 . This is a "BCWELLMARK WEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: IL0182 . This is a "JOHN DEERE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1571232 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com