Healthcare Provider Details

I. General information

NPI: 1518005693
Provider Name (Legal Business Name): MULTNOMAH COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NE 8TH ST 3RD FLOOR
GRESHAM OR
97030-7317
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 503-988-3746
  • Fax: 503-988-3015
Mailing address:
  • Phone: 503-988-7468
  • Fax: 503-988-3015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateOR

VIII. Authorized Official

Name: MS. WENDY LEAR
Title or Position: BUSINESS SERVICES MANAGER
Credential:
Phone: 503-988-7462