Healthcare Provider Details

I. General information

NPI: 1073030730
Provider Name (Legal Business Name): KAISER FOUNDATION HEALTH PLAN NORTHWEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 NE DEKUM ST
PORTLAND OR
97211-6613
US

IV. Provider business mailing address

500 NE MULTNOMAH ST
PORTLAND OR
97232-2023
US

V. Phone/Fax

Practice location:
  • Phone: 800-813-2000
  • Fax: 503-286-6879
Mailing address:
  • Phone: 800-813-2000
  • Fax: 503-286-6879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

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