Provider Demographics
NPI:1851460638
Name:OREGON HEALTH & SCIENCE UNIVERSITY
Entity Type:Organization
Organization Name:OREGON HEALTH & SCIENCE UNIVERSITY
Other - Org Name:OHSU INTERCULTURAL PSYCHIATRIC PROGRAM (OHSU IPP)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, OHSU
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-494-8252
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:MAIL CODE UHN-88, ATTN. LIZ STEVENSON
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-8744
Mailing Address - Fax:503-494-8020
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:MAIL CODE UHN-88, ATTN. LIZ STEVENSON
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-8744
Practice Address - Fax:503-494-8020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR248450Medicaid
R109611Medicare PIN