1952405664 NPI number — DEPT. OF HUMAN SRVCS/OFFICE OF FIN. SRVCS DBA IRS/EOPC/EOTC/OSH/OSH-P

Table of content: (NPI 1952405664)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952405664 NPI number — DEPT. OF HUMAN SRVCS/OFFICE OF FIN. SRVCS DBA IRS/EOPC/EOTC/OSH/OSH-P

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEPT. OF HUMAN SRVCS/OFFICE OF FIN. SRVCS DBA IRS/EOPC/EOTC/OSH/OSH-P
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:
1952405664
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 14900
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97309-5016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-945-9469
Provider Business Mailing Address Fax Number:
503-947-1007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 WESTGATE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENDLETON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97801-9604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-276-0810
Provider Business Practice Location Address Fax Number:
541-278-2209
Provider Enumeration Date:
09/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KITTRELL
Authorized Official First Name:
RUSSELL
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
IRS MANAGER
Authorized Official Telephone Number:
509-945-9440

Provider Taxonomy Codes

  • Taxonomy code: 3336I0012X , with the licence number:  IP 00000 CS , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3842146 . This is a "NCPDP" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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