1275823601 NPI number — ANNE PARKS PATTON QMHA

Table of content: ANNE PARKS PATTON QMHA (NPI 1275823601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275823601 NPI number — ANNE PARKS PATTON QMHA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATTON
Provider First Name:
ANNE
Provider Middle Name:
PARKS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
QMHA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PATTON
Provider Other First Name:
ANNE
Provider Other Middle Name:
PARKS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
QMHA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275823601
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4847 13TH AVE NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEIZER
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97303-3813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-505-3901
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
182 SW ACADEMY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97338-1996
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-623-9289
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2011

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ANNEVALDEZ , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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