Healthcare Provider Details

I. General information

NPI: 1578391314
Provider Name (Legal Business Name): MULTNOMAH COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NE 8TH ST STE 200
GRESHAM OR
97030-7317
US

IV. Provider business mailing address

619 NW 6TH AVE FL 5
PORTLAND OR
97209-3991
US

V. Phone/Fax

Practice location:
  • Phone: 503-988-7468
  • Fax:
Mailing address:
  • Phone: 503-988-7468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: VERONICA LOPEZ-ERICKSEN
Title or Position: PCFH DIRECTOR
Credential:
Phone: 503-701-0578