Provider Demographics
NPI:1558424432
Name:CLACKAMAS EDUCATION SERVICE DISTRICT
Entity Type:Organization
Organization Name:CLACKAMAS EDUCATION SERVICE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GALLIA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:503-675-4151
Mailing Address - Street 1:13455 SE 97TH
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13455 SE 97TH
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015
Practice Address - Country:US
Practice Address - Phone:503-675-4151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR045737OtherSCHOOL BASED PROVIDER