Provider Demographics
NPI:1073896551
Name:PROVIDENCE HEALTH & SERVICES-OREGON
Entity Type:Organization
Organization Name:PROVIDENCE HEALTH & SERVICES-OREGON
Other - Org Name:PROVIDENCE RADIOLOGY-MILL PLAIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SYS DIR RC BUSINESS OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-215-4323
Mailing Address - Street 1:PO BOX 3395
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3395
Mailing Address - Country:US
Mailing Address - Phone:503-215-4323
Mailing Address - Fax:503-215-0297
Practice Address - Street 1:315 SE STONE MILL DR
Practice Address - Street 2:SUITE 102
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6998
Practice Address - Country:US
Practice Address - Phone:360-816-2733
Practice Address - Fax:360-816-2710
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROVIDENCE HEALTH & SERVICES-OREGON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-21
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty