Healthcare Provider Details

I. General information

NPI: 1053630491
Provider Name (Legal Business Name): CAREOREGON COMMUNITY HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17175 SW TUALATIN VALLEY HWY SUITE B-2
BEAVERTON OR
97006-4584
US

IV. Provider business mailing address

315 SW 5TH AVE STE 900
PORTLAND OR
97204-1739
US

V. Phone/Fax

Practice location:
  • Phone: 503-848-5861
  • Fax: 503-848-5863
Mailing address:
  • Phone: 503-416-4100
  • Fax: 503-416-1478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES M. SCHROEDER
Title or Position: EXECUTIVE DIRECTOR
Credential: PA
Phone: 503-416-5764