Provider Demographics
NPI:1922037902
Name:OREGON KIDNEY CENTER
Entity Type:Organization
Organization Name:OREGON KIDNEY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COLLECTIONS SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-584-4228
Mailing Address - Street 1:P.O. BOX 52432
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85072-2432
Mailing Address - Country:US
Mailing Address - Phone:520-751-0616
Mailing Address - Fax:520-751-1211
Practice Address - Street 1:5318 NE IRVING ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-3158
Practice Address - Country:US
Practice Address - Phone:503-284-1939
Practice Address - Fax:503-284-3991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR38-2500Medicare ID - Type Unspecified