Provider Demographics
NPI:1619915774
Name:HOUSECALL PROVIDERS INC
Entity Type:Organization
Organization Name:HOUSECALL PROVIDERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BENNETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HUSTED
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:970-202-5500
Mailing Address - Street 1:5100 SW MACADAM AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-6102
Mailing Address - Country:US
Mailing Address - Phone:971-202-5500
Mailing Address - Fax:971-202-5555
Practice Address - Street 1:5100 SW MACADAM AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-6102
Practice Address - Country:US
Practice Address - Phone:971-202-5500
Practice Address - Fax:971-202-5555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207QG0300X
OR251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
No251G00000XAgenciesHospice Care, Community BasedGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150916Medicaid
101558Medicare PIN
OR150916Medicaid