1710160668 NPI number — BRIAN G ORAHOOD

Table of content: (NPI 1710160668)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710160668 NPI number — BRIAN G ORAHOOD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIAN G ORAHOOD
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:
1710160668
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
965 N CASCADE DR
Provider Second Line Business Mailing Address:
PO BOX 221
Provider Business Mailing Address City Name:
WOODBURN
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97071-3140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-982-1112
Provider Business Mailing Address Fax Number:
503-981-0732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
965 N CASCADE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODBURN
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97071-3140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-982-1112
Provider Business Practice Location Address Fax Number:
503-981-0732
Provider Enumeration Date:
12/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ORAHOOD
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
503-982-1112

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  DP00614 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 080747 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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