Provider Demographics
NPI:1316293921
Name:SAINT HELENS INTERNAL MEDICINE
Entity type:Organization
Organization Name:SAINT HELENS INTERNAL MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JODI
Authorized Official - Middle Name:L
Authorized Official - Last Name:STONAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-366-6244
Mailing Address - Street 1:PO BOX 976
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-0976
Mailing Address - Country:US
Mailing Address - Phone:503-366-6244
Mailing Address - Fax:503-366-6246
Practice Address - Street 1:530 N COLUMBIA RIVER HWY
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-1202
Practice Address - Country:US
Practice Address - Phone:503-366-6244
Practice Address - Fax:503-366-6246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO150772207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500620165Medicaid
OR500620165Medicaid