Healthcare Provider Details

I. General information

NPI: 1861073058
Provider Name (Legal Business Name): CLINICOPS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 OWENS ST SE
SALEM OR
97302-4183
US

IV. Provider business mailing address

2459 SE TUALATIN VALLEY HWY # 416
HILLSBORO OR
97123-7919
US

V. Phone/Fax

Practice location:
  • Phone: 866-972-0235
  • Fax:
Mailing address:
  • Phone: 503-972-0235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JACQUELINE MORRISON NELSON
Title or Position: BILLING ADMINISTRATOR
Credential:
Phone: 503-972-0235