Provider Demographics
NPI:1073757316
Name:MULTNOMAH COUNTY
Entity Type:Organization
Organization Name:MULTNOMAH COUNTY
Other - Org Name:MULTNOMAH COUNTY HEALTH DEPT -CORRECTIONS HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS SERVICES MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-988-3674
Mailing Address - Street 1:421 SW OAK ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-1817
Mailing Address - Country:US
Mailing Address - Phone:503-988-3056
Mailing Address - Fax:503-988-3015
Practice Address - Street 1:1120 SW 3RD AVE
Practice Address - Street 2:DENTENTION CENTER
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-2801
Practice Address - Country:US
Practice Address - Phone:503-988-3976
Practice Address - Fax:503-988-3975
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF MULTNOMAH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-30
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000WCJHTMedicare Oscar/Certification