Provider Demographics
NPI:1366570798
Name:BOURS HEALTH CENTER
Entity type:Organization
Organization Name:BOURS HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ALSOP
Authorized Official - Last Name:BOURS
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:503-357-6119
Mailing Address - Street 1:3303 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-1909
Mailing Address - Country:US
Mailing Address - Phone:503-357-6119
Mailing Address - Fax:503-359-5750
Practice Address - Street 1:3303 19TH AVE
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-1909
Practice Address - Country:US
Practice Address - Phone:503-357-6119
Practice Address - Fax:503-359-5750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD08196207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR263301Medicaid
ORMD08196OtherMEDICAL LICENSE
ORMD08196OtherMEDICAL LICENSE
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