Provider Demographics
NPI:1184918955
Name:PROV HEALTH SYS-OR SHARED-SVS DIV
Entity type:Organization
Organization Name:PROV HEALTH SYS-OR SHARED-SVS DIV
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR - AMB SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-893-6863
Mailing Address - Street 1:9340 SW BARNES RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6623
Mailing Address - Country:US
Mailing Address - Phone:503-216-5641
Mailing Address - Fax:503-216-2039
Practice Address - Street 1:9340 SW BARNES RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6623
Practice Address - Country:US
Practice Address - Phone:503-216-5641
Practice Address - Fax:503-216-2039
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROVIDENCE HEALTH & SERVICES - OREGON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health