Provider Demographics
NPI:1629055702
Name:PORTLAND HYPERTENSION & NEPHROLOGY CLINIC LLP
Entity Type:Organization
Organization Name:PORTLAND HYPERTENSION & NEPHROLOGY CLINIC LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:H
Authorized Official - Last Name:ISRAELIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-284-1937
Mailing Address - Street 1:5314 NE IRVING ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-3158
Mailing Address - Country:US
Mailing Address - Phone:503-284-1937
Mailing Address - Fax:503-284-3908
Practice Address - Street 1:5314 NE IRVING ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-3158
Practice Address - Country:US
Practice Address - Phone:503-284-1937
Practice Address - Fax:503-284-3908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7011513Medicaid
OR287500Medicaid
ORR0000WCHMWMedicare PIN