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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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