Basic Information
Provider Information | |||||||||
NPI: | 1053631747 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | MULTNOMAH COUNTY | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | MULTNOMAH COUNTY HEALTH DEPARTMENT | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 619 NW 6TH AVE STE 500 | ||||||||
Address2: |   | ||||||||
City: | PORTLAND | ||||||||
State: | OR | ||||||||
PostalCode: | 972093964 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5039883663 | ||||||||
FaxNumber: | 5039883015 | ||||||||
Practice Location | |||||||||
Address1: | 619 NW 6TH AVE | ||||||||
Address2: |   | ||||||||
City: | PORTLAND | ||||||||
State: | OR | ||||||||
PostalCode: | 972093964 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5039883666 | ||||||||
FaxNumber: | 5039883015 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/04/2010 | ||||||||
LastUpdateDate: | 03/12/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | LEAR | ||||||||
AuthorizedOfficialFirstName: | WENDY | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | FINANCE DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 5039883674 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | COUNTY OF MULTNOMAH | ||||||||
AuthorizedOfficialNamePrefix: | MS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP0905X |   | OR | N |   | Ambulatory Health Care Facilities | Clinic/Center | Public Health, State or Local | 251B00000X |   | OR | Y |   | Agencies | Case Management |   |
No ID Information.