Provider Demographics
NPI:1245269315
Name:COUNTY OF CLACKAMAS OFFICE OF COUNTY AUDITOR
Entity type:Organization
Organization Name:COUNTY OF CLACKAMAS OFFICE OF COUNTY AUDITOR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH CENTERS CFO
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KEARL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-742-5319
Mailing Address - Street 1:2051 KAEN RD.
Mailing Address - Street 2:SUITE 367
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045
Mailing Address - Country:US
Mailing Address - Phone:503-742-5300
Mailing Address - Fax:503-742-5979
Practice Address - Street 1:6605 SE LAKE ROAD
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222
Practice Address - Country:US
Practice Address - Phone:503-655-8401
Practice Address - Fax:503-655-8429
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF CLACKAMAS OFFICE OF COUNTY AUDITOR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-01
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR251S00000X, 261QR0405X, 261QM0801X
261QF0400X, 261QM0801X, 302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR022710Medicaid
OR131607Medicaid
OR031799Medicaid
ORR0000WCGMWMedicare PIN