Provider Demographics
NPI:1629378880
Name:COLUMBIA LUTHERAN CHARITIES
Entity Type:Organization
Organization Name:COLUMBIA LUTHERAN CHARITIES
Other - Org Name:CMH CARDIOLOGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-338-7505
Mailing Address - Street 1:2111 EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-3329
Mailing Address - Country:US
Mailing Address - Phone:503-325-4321
Mailing Address - Fax:503-338-7586
Practice Address - Street 1:2158 EXCHANGE ST
Practice Address - Street 2:SUITE 206
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3316
Practice Address - Country:US
Practice Address - Phone:503-325-4321
Practice Address - Fax:503-338-7586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14-1146207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR381320Medicare Oscar/Certification