1508876319 NPI number — VIRGINIA GARCIA MEMORIAL HEALTH CENTER

Table of content: (NPI 1508876319)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508876319 NPI number — VIRGINIA GARCIA MEMORIAL HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIRGINIA GARCIA MEMORIAL HEALTH CENTER
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:
1508876319
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6149
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALOHA
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97007-0149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2725 SW CEDAR HILLS BLVD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAVERTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97005-1435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-352-6006
Provider Business Practice Location Address Fax Number:
503-352-6082
Provider Enumeration Date:
08/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HIGDON
Authorized Official First Name:
APRIL
Authorized Official Middle Name:
ETHERIDGE
Authorized Official Title or Position:
DIRECTOR OF PHARMACY
Authorized Official Telephone Number:
503-352-8553

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X , with the licence number:  RP0002336 , 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: 2079470 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 298994 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com