Healthcare Provider Details

I. General information

NPI: 1912322074
Provider Name (Legal Business Name): MULTNOMAH COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2014
Last Update Date: 05/18/2024
Certification Date: 05/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 SE 182ND AVE
GRESHAM OR
97030-5028
US

IV. Provider business mailing address

619 NW 6TH AVE STE 500
PORTLAND OR
97209-3964
US

V. Phone/Fax

Practice location:
  • Phone: 503-988-5488
  • Fax: 503-988-5484
Mailing address:
  • Phone: 503-988-7468
  • Fax: 503-988-3015

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: DERRICK MOTEN
Title or Position: INTERIM BUSINESS SERVICES DIRECTOR
Credential:
Phone: 503-988-2966