Provider Demographics
NPI:1073054714
Name:UNIVERSITY PROFESSIONAL SERVICES
Entity Type:Organization
Organization Name:UNIVERSITY PROFESSIONAL SERVICES
Other - Org Name:OHSU HOME INFUSION PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, ERC
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-494-8417
Mailing Address - Street 1:1400 SW 5TH AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5537
Mailing Address - Country:US
Mailing Address - Phone:503-494-8417
Mailing Address - Fax:503-346-8015
Practice Address - Street 1:9317 SW NIMBUS AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008
Practice Address - Country:US
Practice Address - Phone:503-346-3850
Practice Address - Fax:503-346-3851
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY PROFESSIONAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-14
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163W00000X, 163WI0500X, 332BP3500X
ORRP-0003214-CS332B00000X, 333600000X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR7649620001OtherMEDICARE NSC