Basic Information
| Provider Information | |||||||||
| NPI: | 1619915774 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOUSECALL PROVIDERS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5100 SW MACADAM AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972396102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9712025500 | ||||||||
| FaxNumber: | 9712025555 | ||||||||
| Practice Location | |||||||||
| Address1: | 5100 SW MACADAM AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972396102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9712025500 | ||||||||
| FaxNumber: | 9712025555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 01/24/2013 | ||||||||
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| AuthorizedOfficialLastName: | HUSTED | ||||||||
| AuthorizedOfficialFirstName: | BENNETH | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9702025500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | OR | N | Agencies | Hospice Care, Community Based | 207QG0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 150916 | 05 | OR | MEDICAID |