Provider Demographics
NPI:1316723711
Name:DEEP INSIGHT PLLC
Entity type:Organization
Organization Name:DEEP INSIGHT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL CONTRACTING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-819-6585
Mailing Address - Street 1:6400 SE LAKE RD STE 135
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97222-2189
Mailing Address - Country:US
Mailing Address - Phone:888-830-6088
Mailing Address - Fax:888-850-5616
Practice Address - Street 1:2255 NW SHEVLIN PARK RD STE 120
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-7134
Practice Address - Country:US
Practice Address - Phone:888-830-6088
Practice Address - Fax:888-850-5616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-01
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty