Provider Demographics
NPI:1932109840
Name:WEST HILLS GASTROENTEROLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:WEST HILLS GASTROENTEROLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SNOOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-517-9612
Mailing Address - Street 1:9701 SW BARNES RD
Mailing Address - Street 2:#300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6772
Mailing Address - Country:US
Mailing Address - Phone:503-297-8081
Mailing Address - Fax:503-292-6601
Practice Address - Street 1:9701 SW BARNES RD
Practice Address - Street 2:#300
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6772
Practice Address - Country:US
Practice Address - Phone:503-297-8081
Practice Address - Fax:503-292-6601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7054604207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR239699Medicaid
OROOOOWCHNTMedicare ID - Type Unspecified