Healthcare Provider Details

I. General information

NPI: 1093043424
Provider Name (Legal Business Name): KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2009
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 N INTERSTATE AVE
PORTLAND OR
97227-1106
US

IV. Provider business mailing address

500 NE MULTNOMAH ST
PORTLAND OR
97232-2023
US

V. Phone/Fax

Practice location:
  • Phone: 503-280-2931
  • Fax:
Mailing address:
  • Phone: 503-813-4939
  • Fax: 503-813-4967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

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