Provider Demographics
NPI:1861038382
Name:CLACKAMAS COUNTY
Entity Type:Organization
Organization Name:CLACKAMAS COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHASE HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-655-8700
Mailing Address - Street 1:2051 KAEN RD STE 210
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4035
Mailing Address - Country:US
Mailing Address - Phone:503-655-8700
Mailing Address - Fax:503-650-5656
Practice Address - Street 1:2051 KAEN RD STE 210
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4035
Practice Address - Country:US
Practice Address - Phone:503-655-8700
Practice Address - Fax:503-650-5656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center