Provider Demographics
NPI:1487902706
Name:OREGON HEALTH & SCIENCE UNIVERSITY
Entity type:Organization
Organization Name:OREGON HEALTH & SCIENCE UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:O
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-494-8252
Mailing Address - Street 1:4212 SE DIVISION ST STE 150
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-1681
Mailing Address - Country:US
Mailing Address - Phone:503-418-1500
Mailing Address - Fax:503-418-3939
Practice Address - Street 1:4212 SE DIVISION ST STE 150
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-1681
Practice Address - Country:US
Practice Address - Phone:503-418-1500
Practice Address - Fax:503-418-3939
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OREGON HEALTH & SCIENCE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-16
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500682277Medicaid
ORR131418Medicare PIN
OR381938Medicare Oscar/Certification