Provider Demographics
NPI:1285741769
Name:COLUMBIA VIEW FAMILY HEALTH CENTER P C
Entity type:Organization
Organization Name:COLUMBIA VIEW FAMILY HEALTH CENTER P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:DASKALOS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:503-667-7711
Mailing Address - Street 1:2800 SW 257TH AVE.
Mailing Address - Street 2:
Mailing Address - City:TROUTDALE
Mailing Address - State:OR
Mailing Address - Zip Code:97060-1803
Mailing Address - Country:US
Mailing Address - Phone:503-667-7711
Mailing Address - Fax:503-669-9908
Practice Address - Street 1:2800 SW 257TH AVE.
Practice Address - Street 2:
Practice Address - City:TROUTDALE
Practice Address - State:OR
Practice Address - Zip Code:97060-1803
Practice Address - Country:US
Practice Address - Phone:503-667-7711
Practice Address - Fax:503-669-9908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO21257207Q00000X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
024477000OtherREGENCE BLUE CROSS OF OR
OR001375Medicaid
0000WCJDNMedicare ID - Type Unspecified
OR001375Medicaid