1972939650 NPI number — THE OREGON CLINIC, PC

Table of content: (NPI 1972939650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972939650 NPI number — THE OREGON CLINIC, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE OREGON CLINIC, PC
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:
THE OREGON CLINIC OBGYN
Provider Other Organization Name Type Code:
5
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:
1972939650
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
847 NE 19TH AVE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97232-2684
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-963-2801
Provider Business Mailing Address Fax Number:
503-963-2825

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5050 NE HOYT ST
Provider Second Line Business Practice Location Address:
SUITE 421
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97213-2991
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-935-8445
Provider Business Practice Location Address Fax Number:
503-935-8446
Provider Enumeration Date:
09/25/2013

Additional Information

Authorized Official

Authorized Official Last Name:
FAUSEL
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
503-963-2801

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  160412 , 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: 500668062 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com