Provider Demographics
NPI:1740353796
Name:COLUMBIA ORTHOPAEDIC ASSOCIATES PC
Entity type:Organization
Organization Name:COLUMBIA ORTHOPAEDIC ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:WOOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-253-1223
Mailing Address - Street 1:10101 SE MAIN ST
Mailing Address - Street 2:STE 3008
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2458
Mailing Address - Country:US
Mailing Address - Phone:503-253-1223
Mailing Address - Fax:503-253-1530
Practice Address - Street 1:10101 SE MAIN ST
Practice Address - Street 2:STE 3008
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2458
Practice Address - Country:US
Practice Address - Phone:503-253-1223
Practice Address - Fax:503-253-1530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20670174400000X
ORMD23691174400000X
ORMD23565174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR286838Medicaid
OR286682Medicaid
OR286747Medicaid
ORR112766Medicare PIN
ORR114076Medicare PIN
ORH57948Medicare UPIN
ORR112764Medicare PIN
ORR112765Medicare PIN
OR286747Medicaid
OR286682Medicaid
ORR139492Medicare PIN
ORG36827Medicare UPIN