# KAISER FOUNDATION HEALTH PLAN NORTHWEST

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** KAISER FOUNDATION HEALTH PLAN NORTHWEST
- **Other names:** Kaiser Permanente 3 to PhD Wellness Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1073030730
- **Legal business name:** KAISER FOUNDATION HEALTH PLAN NORTHWEST
- **Authorized official:** STEPHEN SHAWN BARTON (EXECUTIVE DIRECTOR, REVENUE CYCLE)
- **Authorized official phone:** (503) 813-2440

## Contact information

- **Practice address:** 2930 NE DEKUM ST, PORTLAND, OR 97211-6613
- **Practice address phone:** (800) 813-2000
- **Practice address fax:** (503) 286-6879
- **Mailing address:** 500 NE MULTNOMAH ST, PORTLAND, OR 97232-2023
- **Mailing address phone:** (800) 813-2000
- **Mailing address fax:** (503) 286-6879

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163W00000X | Registered Nurse | — | NULL | — |
| 163W00000X | Registered Nurse | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |
| 364S00000X | Clinical Nurse Specialist | — | NULL | — |
| 364S00000X | Clinical Nurse Specialist | — | — | — |

## Other

- **Enumeration date:** 08/24/2017
- **Last updated:** 06/01/2021