Provider Demographics
NPI:1518251396
Name:PROV HEALTH SYS-OR SHARED SYS DIV
Entity Type:Organization
Organization Name:PROV HEALTH SYS-OR SHARED SYS DIV
Other - Org Name:PROVIDENCE EMPLOYEE CLINIC - THE PLAZA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE DIRECTOR, AMB SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-893-6523
Mailing Address - Street 1:4400 NE HALSEY ST BLDG II
Mailing Address - Street 2:SUITE 495
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1545
Mailing Address - Country:US
Mailing Address - Phone:503-893-6523
Mailing Address - Fax:503-893-6680
Practice Address - Street 1:5050 NE HOYT ST
Practice Address - Street 2:SUITE B48
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2944
Practice Address - Country:US
Practice Address - Phone:503-215-6019
Practice Address - Fax:503-215-6381
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROVIDENCE HEALTH & SERVICES - OREGON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine