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General NPI Number Information
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NPI Number | 1518251396
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Entity Type | Organization
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Legal Business Name | PROV HEALTH SYS-OR SHARED SYS DIV
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Dates
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Enumeration Date | 06/08/2011
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Last Update Date | 06/08/2011
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Provider Practice Location Address
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Address Line | 5050 NE HOYT ST SUITE B48
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City | PORTLAND
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State | OR
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Zip | 97213-2944
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Country | US
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Telephone | 503-215-6019
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Fax | 503-215-6381
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Provider Business Mailing Address
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Address Line | 4400 NE HALSEY ST BLDG II SUITE 495
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City | PORTLAND
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State | OR
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Zip | 97213-1545
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Country | US
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Telephone | 503-893-6523
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Fax | 503-893-6680
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Authorized Official
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Title or Position | FINANCE DIRECTOR, AMB SERVICES
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Name | MS. REBECCA MARIE WILLIAMS
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Credential |
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Telephone | 503-893-6523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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