Provider Demographics
NPI:1407418999
Name:MULTNOMAH COUNTY
Entity Type:Organization
Organization Name:MULTNOMAH COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-988-7462
Mailing Address - Street 1:619 NW 6TH AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3964
Mailing Address - Country:US
Mailing Address - Phone:503-988-7468
Mailing Address - Fax:
Practice Address - Street 1:1120 SW 3RD AVE
Practice Address - Street 2:DETENTION CENTER
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-2828
Practice Address - Country:US
Practice Address - Phone:503-988-3976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MULTNOMAH COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR022959Medicaid