Provider Demographics
NPI:1780823823
Name:UNIVERSITY PROFESSIONAL SERVICES
Entity Type:Organization
Organization Name:UNIVERSITY PROFESSIONAL SERVICES
Other - Org Name:UNIVERSITY PROFESSIONAL SERVICES PLC-011
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE DEAN
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HECKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-494-4481
Mailing Address - Street 1:PO BOX 3590
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3590
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:891 23RD ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1793
Practice Address - Country:US
Practice Address - Phone:503-494-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY PROFESSIONAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty