Provider Demographics
NPI:1609824010
Name:OREGON HEALTH & SCIENCE UNIVERSITY
Entity Type:Organization
Organization Name:OREGON HEALTH & SCIENCE UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VICE PRESIDENT/CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:DOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-494-8548
Mailing Address - Street 1:2525 SW 3RD AVE STE 245
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-4901
Mailing Address - Country:US
Mailing Address - Phone:503-494-8548
Mailing Address - Fax:
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-8744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208D00000X
OR141008282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3358801Medicaid
OR041178Medicaid
OR041138Medicaid
380009A000000OtherMEDICARE SECTION 1011
380009A000000OtherMEDICARE SECTION 1011
OR041178Medicaid
ORR0000ZGBLPMedicare PIN