Provider Demographics
NPI:1063230480
Name:OUTSIDE IN
Entity type:Organization
Organization Name:OUTSIDE IN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPPORT SERVICES DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:ARONSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-278-2514
Mailing Address - Street 1:1132 SW 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1195 SW 11TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2006
Practice Address - Country:US
Practice Address - Phone:503-535-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OUTSIDE IN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)