Healthcare Provider Details

I. General information

NPI: 1902062672
Provider Name (Legal Business Name): COLUMBIA LUTHERAN CHARITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2008
Last Update Date: 08/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 EXCHANGE ST SUITE 102
ASTORIA OR
97103-3365
US

IV. Provider business mailing address

2111 EXCHANGE ST
ASTORIA OR
97103-3329
US

V. Phone/Fax

Practice location:
  • Phone: 503-325-7888
  • Fax:
Mailing address:
  • Phone: 503-325-4321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number141146
License Number StateOR

VIII. Authorized Official

Name: ERIK W THORSEN
Title or Position: COO
Credential:
Phone: 503-325-4321