Healthcare Provider Details

I. General information

NPI: 1972688919
Provider Name (Legal Business Name): OREGON HEALTH & SCIENCE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 04/08/2022
Certification Date: 04/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 SW GAINES ST
PORTLAND OR
97239-2901
US

IV. Provider business mailing address

PO BOX 3595
PORTLAND OR
97208-3595
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-8716
  • Fax: 503-494-2721
Mailing address:
  • Phone: 503-494-2709
  • Fax: 503-494-6868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANNY O. JACOBS
Title or Position: PRESIDENT
Credential:
Phone: 503-494-8252