1063040186 NPI number — KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST

Table of content: (NPI 1063040186)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063040186 NPI number — KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST
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:
6
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:
1063040186
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5725 NE 138TH AVE
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:
97230-3409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-973-0498
Provider Business Mailing Address Fax Number:
541-225-3408

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
360 S GARDEN WAY STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97401-8173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-973-0498
Provider Business Practice Location Address Fax Number:
541-225-3408
Provider Enumeration Date:
04/01/2020

Additional Information

Authorized Official

Authorized Official Last Name:
BARTON
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
SHAWN
Authorized Official Title or Position:
EXECUTIVE DIRECTOR, REVENUE CYCLE
Authorized Official Telephone Number:
503-813-2440

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com