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NPI Code Detail

MEDICARE: KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST

MEDICARE: KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0002XClinic Pharmacy
23336M0003XManaged Care Organization PharmacyRP-0000717-CSOR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22077391OTHERPK
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013963131
Entity Type Code : Organization
Provider Name (Legal Business Name) : KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST
Provider Business Mailing Address
First Line : 3550 N INTERSTATE AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97227-1196
Country : US
Telephone Number : 866-279-6122
Fax Number : 503-249-3438
Provider Business Practice Location Address
First Line : 3550 N INTERSTATE AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97227-1196
Country : US
Telephone Number : 866-279-6122
Fax Number : 503-249-3438
Authorized Official
Title or Position : EXECUTIVE DIRECTOR, REVENUE CYCLE
Name : STEPHEN SHAWN BARTON
Credential :
Telephone Number : 800-813-2000
Provider Enumeration Date : 05/26/2006
Last Update Date : 06/23/2022

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Directions to “KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST ” Practice Location

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