Provider Demographics
NPI:1508802489
Name:DHS/OFFICE OF FINANCIAL SERVICES IRS/EOPC/BMRC/EOTC/OSH/OSH-P
Entity Type:Organization
Organization Name:DHS/OFFICE OF FINANCIAL SERVICES IRS/EOPC/BMRC/EOTC/OSH/OSH-P
Other - Org Name:OREGON STATE HOSPITAL (SALEM)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMIESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-947-2676
Mailing Address - Street 1:PO BOX 14900
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97309-5016
Mailing Address - Country:US
Mailing Address - Phone:503-945-9840
Mailing Address - Fax:503-947-1007
Practice Address - Street 1:2600 CENTER ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2669
Practice Address - Country:US
Practice Address - Phone:503-945-2800
Practice Address - Fax:503-945-2807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR140160283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500670567Medicaid
ORR0000ZBBWMMedicare PIN
OR400028Medicaid