1891782868 NPI number — PATRICK S O'HOLLAREN MD

Table of content: PATRICK S O'HOLLAREN MD (NPI 1891782868)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891782868 NPI number — PATRICK S O'HOLLAREN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'HOLLAREN
Provider First Name:
PATRICK
Provider Middle Name:
S
Provider Name Prefix Text:
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:
1891782868
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3158
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:
97208-3158
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:
9427 SW BARNES RD STE 395
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97225-6652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-216-6050
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2005

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: 2088P0231X , with the licence number:  MD18712 , 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: 64795 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8156036 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: A016 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 003395010 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0034023 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0565A . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: MD8720R , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 930766376 . This is a "CAREOREGON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8156036 . This is a "COLUMBIA UNITED PF" identifier . This identifiers is of the category "OTHER".
  • Identifier: F81042 . This is a "PROVIDENCE HEALTH" identifier . This identifiers is of the category "OTHER".




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