Provider Demographics
| NPI: | 1275821266 |
|---|---|
| Name: | CLINICOPS, LLC |
| Entity Type: | Organization |
| Organization Name: | CLINICOPS, LLC |
| Other - Org Name: | OREGON INTEGRATED HEALTH |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | PHYSICIAN |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | VANESSA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | ESTEVES |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | ND, MBA |
| Authorized Official - Phone: | 503-972-0235 |
| Mailing Address - Street 1: | 2459 SE TUALATIN VALLEY HWY |
| Mailing Address - Street 2: | SUITE 416 |
| Mailing Address - City: | HILLSBORO |
| Mailing Address - State: | OR |
| Mailing Address - Zip Code: | 97123-1247 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 503-972-0235 |
| Mailing Address - Fax: | 971-216-4964 |
| Practice Address - Street 1: | 1427 NW FLANDERS STREET |
| Practice Address - Street 2: | SUITE A |
| Practice Address - City: | PORTLAND |
| Practice Address - State: | OR |
| Practice Address - Zip Code: | 97209-2646 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 503-972-0235 |
| Practice Address - Fax: | 503-379-1523 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2011-07-12 |
| Last Update Date: | 2021-05-03 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| OR | 101YM0800X | |
| 103TP0016X, 111NS0005X, 171100000X, 207Q00000X, 225700000X, 261Q00000X, 261QM0801X, 363LF0000X, 363LP0808X, 364SP0808X | ||
| OR | 1671 | 175F00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 103TP0016X | Behavioral Health & Social Service Providers | Psychologist | Prescribing (Medical) | Group - Multi-Specialty |
| No | 111NS0005X | Chiropractic Providers | Chiropractor | Sports Physician | Group - Multi-Specialty |
| No | 171100000X | Other Service Providers | Acupuncturist | Group - Multi-Specialty | |
| No | 175F00000X | Other Service Providers | Naturopath | Group - Multi-Specialty | |
| No | 225700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | Group - Multi-Specialty | |
| No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | Group - Multi-Specialty | |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
| No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
| No | 364SP0808X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| OR | 500642226 | Medicaid | |
| OR | 500692262 | Medicaid | |
| OR | 500642226 | Medicaid | |
| OR | R184685 | Medicare PIN |
