Provider Demographics
NPI:1225412620
Name:NATIONAL UNIVERSITY OF NATURAL MEDICINE
Entity type:Organization
Organization Name:NATIONAL UNIVERSITY OF NATURAL MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CMO AND DEAN OF CLINICS
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:IDA
Authorized Official - Last Name:DEHEN
Authorized Official - Suffix:
Authorized Official - Credentials:ND LAC
Authorized Official - Phone:503-552-1966
Mailing Address - Street 1:049 SW PORTER ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-4848
Mailing Address - Country:US
Mailing Address - Phone:503-552-1551
Mailing Address - Fax:503-226-8133
Practice Address - Street 1:3025 SW CORBETT AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-4858
Practice Address - Country:US
Practice Address - Phone:503-552-1551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL UNIVERSITY OF NATURAL MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-15
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORND0879261QP2300X
OR0879261QS1000X, 332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR137646Medicaid