Healthcare Provider Details

I. General information

NPI: 1629520697
Provider Name (Legal Business Name): KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5940 ULALI DR NE
KEIZER OR
97303-1500
US

IV. Provider business mailing address

500 NE MULTNOMAH ST
PORTLAND OR
97232-2023
US

V. Phone/Fax

Practice location:
  • Phone: 800-813-2000
  • Fax: 503-286-6879
Mailing address:
  • Phone: 800-813-2000
  • Fax: 503-286-6879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: STEPHEN SHAWN BARTON
Title or Position: EXECUTIVE DIRECTOR, REVENUE CYCLE
Credential:
Phone: 503-813-2440