MEDICARE: CLACKAMAS COUNTY

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
1	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

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

General Provider Information

NPI Number	:	1720017809
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLACKAMAS COUNTY

Provider Business Mailing Address
First Line	:	2051 KAEN RD
Second Line	:	SUITE 367
City	:	OREGON CITY
State	:	OR
Zip	:	97045-4035
Country	:	US
Telephone Number	:	503-742-5300
Fax Number	:	503-655-8350

Provider Business Practice Location Address
First Line	:	110 BEAVERCREEK RD STE 100
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-4307
Country	:	US
Telephone Number	:	503-655-8471
Fax Number	:	503-655-8595

Authorized Official
Title or Position	:	CFO
Name	:	ED JOHNSON
Credential	:
Telephone Number	:	503-742-5325

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	09/24/2019

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Directions to “CLACKAMAS COUNTY ” Practice Location

Language	Start Address	Practice Location

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