Healthcare Provider Details

I. General information

NPI: 1043566847
Provider Name (Legal Business Name): CLACKAMAS COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2012
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37400 SE BELL STREET
SANDY OR
97055
US

IV. Provider business mailing address

2051 KAEN RD SUITE 367
OREGON CITY OR
97045-4035
US

V. Phone/Fax

Practice location:
  • Phone: 503-668-3483
  • Fax: 503-668-1892
Mailing address:
  • Phone: 503-742-5300
  • Fax: 503-655-8350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: SARAH JACOBSON
Title or Position: DIRECTOR - INTERIM
Credential:
Phone: 503-201-1890