Provider Demographics
NPI:1811363310
Name:PACIFIC UNIVERSITY
Entity Type:Organization
Organization Name:PACIFIC UNIVERSITY
Other - Org Name:STUDENT HEALTH CENTER-FOREST GROVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWNING
Authorized Official - Suffix:
Authorized Official - Credentials:NCMA
Authorized Official - Phone:503-352-2663
Mailing Address - Street 1:2043 COLLEGE WAY
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-1756
Mailing Address - Country:US
Mailing Address - Phone:503-352-2258
Mailing Address - Fax:
Practice Address - Street 1:2142 COLLEGE WAY
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-1727
Practice Address - Country:US
Practice Address - Phone:503-352-2269
Practice Address - Fax:503-352-3105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service