Healthcare Provider Details

I. General information

NPI: 1417333535
Provider Name (Legal Business Name): ASCENSION HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2015
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8083 SE 13TH AVE SUITE #3
PORTLAND OR
97202-6668
US

IV. Provider business mailing address

8083 SE 13TH AVE SUITE #3
PORTLAND OR
97202-6668
US

V. Phone/Fax

Practice location:
  • Phone: 971-533-5840
  • Fax:
Mailing address:
  • Phone: 971-533-5840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMD18862
License Number StateOR

VIII. Authorized Official

Name: JOHN HARDY
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 503-407-8286