Healthcare Provider Details

I. General information

NPI: 1023832326
Provider Name (Legal Business Name): OREGON DEPARTMENT OF CORRECTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 WESTGATE
PENDLETON OR
97801
US

IV. Provider business mailing address

2757 22ND ST SE
SALEM OR
97302
US

V. Phone/Fax

Practice location:
  • Phone: 503-428-9443
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2400X
TaxonomyPrison Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROB CORY NUTT
Title or Position: CHIEF PHARMACY OFFICER
Credential:
Phone: 503-986-6967