Provider Demographics
NPI:1336758630
Name:ALAS, TED
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:
Last Name:ALAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 CENTER ST NE STE 2100
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4592
Mailing Address - Country:US
Mailing Address - Phone:971-718-1487
Mailing Address - Fax:
Practice Address - Street 1:3180 CENTER ST NE STE 2100
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4592
Practice Address - Country:US
Practice Address - Phone:503-378-7526
Practice Address - Fax:503-480-1595
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000003999172V00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker