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Organization
UNIVERSITY PROFESSIONAL SERVICES
Active
Organization
UNIVERSITY PROFESSIONAL SERVICES
Active
Other names
UPS Gabriel Park (OHA PCPCH)
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY SMITH (VICE PRESIDENT, ERC)
(503) 494-8417
Entity
Organization
Contact information
Practice address
4411 SW VERMONT ST, PORTLAND, OR 97219-1020
(503) 494-9992
Mailing address
1400 SW 5TH AVE STE 500, PORTLAND, OR 97201-5537
(503) 494-8417
(503) 346-8015
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500646498 (MCD)
—
OR
Enumeration date
08/07/2012
Last updated
08/03/2022
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