Basic Information
| Provider Information | |||||||||
| NPI: | 1417975152 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WOMEN'S HEALTH CENTER OF OREGON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1508 DIVISION ST | ||||||||
| Address2: | STE 205 | ||||||||
| City: | OREGON CITY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970451582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036571071 | ||||||||
| FaxNumber: | 5036573321 | ||||||||
| Practice Location | |||||||||
| Address1: | 1508 DIVISION ST | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | OREGON CITY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970451582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036571071 | ||||||||
| FaxNumber: | 5036573321 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 02/21/2012 | ||||||||
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| AuthorizedOfficialLastName: | BANCKE | ||||||||
| AuthorizedOfficialFirstName: | TINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 5039054361 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD22411 | OR | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.