Provider Demographics
NPI:1740066950
Name:REPERIO HEALTH, INC.
Entity type:Organization
Organization Name:REPERIO HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-522-8024
Mailing Address - Street 1:4784 SE 17TH AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-4715
Mailing Address - Country:US
Mailing Address - Phone:844-504-0402
Mailing Address - Fax:503-296-5806
Practice Address - Street 1:4784 SE 17TH AVE STE 120
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-4715
Practice Address - Country:US
Practice Address - Phone:844-504-0402
Practice Address - Fax:503-296-5806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-04
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty