Healthcare Provider Details

I. General information

NPI: 1194568469
Provider Name (Legal Business Name): OHSU OUTPATIENT CLINICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 NE 2ND AVE
PORTLAND OR
97212-3932
US

IV. Provider business mailing address

1400 SW 5TH AVE FL 5
PORTLAND OR
97201-5509
US

V. Phone/Fax

Practice location:
  • Phone: 503-346-4949
  • Fax:
Mailing address:
  • Phone: 503-494-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: SANDRA CATALAN
Title or Position: VP, CONTROLLER
Credential:
Phone: 34-943-1015